Provider Demographics
NPI:1558669606
Name:GUSIC, DZANAN (FNP)
Entity type:Individual
Prefix:
First Name:DZANAN
Middle Name:
Last Name:GUSIC
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 NORTON COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7020
Mailing Address - Country:US
Mailing Address - Phone:502-618-2472
Mailing Address - Fax:
Practice Address - Street 1:9501 NORTON COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7020
Practice Address - Country:US
Practice Address - Phone:502-618-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006890363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK022370OtherMEDICARE- NICC