Provider Demographics
NPI:1053034421
Name:BLUECRESCENT URGENT CARE LLC
Entity type:Organization
Organization Name:BLUECRESCENT URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:703-598-3441
Mailing Address - Street 1:3809 42ND AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3503
Mailing Address - Country:US
Mailing Address - Phone:612-405-3554
Mailing Address - Fax:
Practice Address - Street 1:3809 42ND AVE S STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3503
Practice Address - Country:US
Practice Address - Phone:612-405-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty