Provider Demographics
NPI:1215257159
Name:NUSSBAUM, JEANNETTE KAY (RN)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:KAY
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8759 STONEHOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1912
Mailing Address - Country:US
Mailing Address - Phone:410-465-7548
Mailing Address - Fax:410-465-8471
Practice Address - Street 1:8759 STONEHOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-1912
Practice Address - Country:US
Practice Address - Phone:410-465-7548
Practice Address - Fax:410-465-8471
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR078947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG1157OtherWCCM