Individual provider Active NPI

Gratious Nyasha Mushura

  • Rehabilitation Registered Nurse
  • Rio Rancho, NM
National Provider Identifier
1255023859
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Registered NurseTaxonomy code 163WR0400X
License
54756 Issued in NM
Practice address
3317 Berkshire Rd NE
Rio Rancho, NM 87144-1624
Phone
(615) 635-2789
NPI assigned
May 22, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Registered Nurse 163WR0400X 54756 NM Primary

Addresses

Primary practice location

3317 Berkshire Rd NE
Rio Rancho, NM 87144-1624

Mailing address

3317 Berkshire Rd NE
Rio Rancho, NM 87144-1624
Phone (615) 635-2789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
54756NMMDRehabilitation Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1255023859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 BERKSHIRE RD NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871441624",
            "telephone_number": "615-635-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 BERKSHIRE RD NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871441624",
            "telephone_number": "615-635-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSHURA",
        "first_name": "GRATIOUS",
        "middle_name": "NYASHA",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "NM",
            "license": "54756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.