Provider Demographics
NPI:1730721960
Name:MUSILI, CHARLESANNA LANGSTON
Entity type:Individual
Prefix:
First Name:CHARLESANNA
Middle Name:LANGSTON
Last Name:MUSILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 DIAZ AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5803
Mailing Address - Country:US
Mailing Address - Phone:214-783-8242
Mailing Address - Fax:
Practice Address - Street 1:5825 DIAZ AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5803
Practice Address - Country:US
Practice Address - Phone:214-783-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196310164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse