Individual ProviderNesreen MustafaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669(414) 385-2543(800) 326-2250PECOS EnrollmentBased on the most recent information from CMS, provider Nesreen Mustafa is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:26 AM.Profile DetailsProvider ID1326863051Provider TypeIndividualFull NameMustafa, NesreenCredentialPAGenderFemaleSole ProprietorNoEnumeration Date11/18/2024Last Updated3/18/2025Contact InformationPractice LocationPractice Address2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669Phone(414) 385-2543FaxUnlisted FaxMailing LocationMailing AddressPO Box 735044, Chicago, IL 60673-5044Phone(800) 326-2250FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense8207-23WisconsinProvider IdentifiersIDDescriptionIssuerID100309479DescriptionMedicaidIssuerUnlistedWisconsin