Provider Demographics
NPI:1528004371
Name:NUSSEN, JANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:
Last Name:NUSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:2205 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2948
Practice Address - Country:US
Practice Address - Phone:757-825-4273
Practice Address - Fax:757-825-4276
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010203538Medicaid
96723OtherSENTARA
VA180680OtherBCBS
VA180680OtherHKEEPER
VA180680OtherBCBS
VA190001334Medicare ID - Type Unspecified