Provider Demographics
NPI:1124634753
Name:GUSSAK, MARIA LUISA (ND)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:GUSSAK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S WENATCHEE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2295
Mailing Address - Country:US
Mailing Address - Phone:509-537-3660
Mailing Address - Fax:833-390-1316
Practice Address - Street 1:5 S WENATCHEE AVE STE 301
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2295
Practice Address - Country:US
Practice Address - Phone:509-537-3660
Practice Address - Fax:833-390-1316
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61107677202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine