Provider Demographics
NPI:1124543418
Name:NUSSBAUM, DANIEL JACOB
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 NW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1795
Mailing Address - Country:US
Mailing Address - Phone:515-276-9166
Mailing Address - Fax:
Practice Address - Street 1:812 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1902
Practice Address - Country:US
Practice Address - Phone:877-462-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer