Provider Demographics
NPI:1194089805
Name:BARSUASKAS, GARY WILSON (NP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WILSON
Last Name:BARSUASKAS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:CUTTEN
Mailing Address - State:CA
Mailing Address - Zip Code:95534
Mailing Address - Country:US
Mailing Address - Phone:707-616-9086
Mailing Address - Fax:707-822-5442
Practice Address - Street 1:4677 VALLEY WEST BLVD.
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-822-5244
Practice Address - Fax:707-822-5442
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582770/12889363LX0106X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health