Provider Demographics
NPI:1295392389
Name:NANCY M HUSSAR LLC
Entity Type:Organization
Organization Name:NANCY M HUSSAR LLC
Other - Org Name:WILDERNESS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:540-755-7157
Mailing Address - Street 1:4444 GERMANNA HWY STE 330
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-2044
Mailing Address - Country:US
Mailing Address - Phone:540-755-7157
Mailing Address - Fax:540-755-2846
Practice Address - Street 1:4444 GERMANNA HWY STE 330
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2044
Practice Address - Country:US
Practice Address - Phone:540-755-7157
Practice Address - Fax:540-755-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024171389OtherSTATE LICENSE