Provider Demographics
NPI:1265671473
Name:KUSSER, STEPHANIE M (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:KUSSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-583-6086
Mailing Address - Fax:
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1445
Practice Address - Country:US
Practice Address - Phone:310-214-5722
Practice Address - Fax:310-793-3756
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564744163W00000X
CA18511363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA564744OtherRN LICENSE
CAG1108185OtherNP CERTIFICAITON
CA3054OtherCNS LICENSE