Provider Demographics
NPI:1407289580
Name:NESBIT, SUNDE MICHELE (PHD)
Entity Type:Individual
Prefix:
First Name:SUNDE
Middle Name:MICHELE
Last Name:NESBIT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 WESTLAWN DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4001
Mailing Address - Country:US
Mailing Address - Phone:765-532-7955
Mailing Address - Fax:
Practice Address - Street 1:408 DOUGLAS AVE STE C
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6260
Practice Address - Country:US
Practice Address - Phone:515-232-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600675432Medicaid