Basic Information
Provider Information
NPI: 1437715257
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUSSER
FirstName: RYANN
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: CRNP, FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LEITH
OtherFirstName: RYANN
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 224D CORNWALL ST NW STE 403
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762704
CountryCode: US
TelephoneNumber: 7037376001
FaxNumber:  
Practice Location
Address1: 19490 SANDRIDGE WAY STE 210
Address2:  
City: LEESBURG
State: VA
PostalCode: 201763467
CountryCode: US
TelephoneNumber: 7037237504
FaxNumber: 7037237550
Other Information
ProviderEnumerationDate: 05/16/2019
LastUpdateDate: 05/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR206143MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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