Provider Demographics
NPI:1184630741
Name:NUESSLE, NANETTE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:S
Last Name:NUESSLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANETTE
Other - Middle Name:S
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11630 N REEMS RD
Mailing Address - Street 2:#2051
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:913-948-3323
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD
Practice Address - Street 2:BLDG 1130
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85309
Practice Address - Country:US
Practice Address - Phone:623-856-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34846208000000X
IL036-087877208000000X
AZ47491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087877 1Medicaid
04-34846OtherKANSAS LICENSE
279500OtherMEDICARE GROUP
IL0407950001Medicare NSC
279500OtherMEDICARE GROUP
ILF73457Medicare UPIN