Provider Demographics
NPI:1417297177
Name:DUSHA, MARGUERITE M (APRN, ANP-BC, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:M
Last Name:DUSHA
Suffix:
Gender:F
Credentials:APRN, ANP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-1341
Mailing Address - Country:US
Mailing Address - Phone:518-654-7680
Mailing Address - Fax:518-654-7693
Practice Address - Street 1:200 SMITH DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1341
Practice Address - Country:US
Practice Address - Phone:518-654-7680
Practice Address - Fax:518-654-7693
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337965363LP2300X, 363LF0000X
RINPP37881363LF0000X
VT101-0111834363LF0000X, 363L00000X, 363LA2200X
NYF306328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03552527Medicaid
VT1021566Medicaid
V4002427015Medicare UPIN