Provider Demographics
NPI:1013359447
Name:NUSSENBAUM, MARLIEKE E (MD)
Entity Type:Individual
Prefix:
First Name:MARLIEKE
Middle Name:E
Last Name:NUSSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLIEKE
Other - Middle Name:ELISABETH
Other - Last Name:DE BRUIJN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 BOULEVARD SE APT 629
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3961
Mailing Address - Country:US
Mailing Address - Phone:919-360-5327
Mailing Address - Fax:
Practice Address - Street 1:1015 BOULEVARD SE APT 629
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3961
Practice Address - Country:US
Practice Address - Phone:919-360-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012798892086S0102X
SC907612086S0102X
FL1650352086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care