Provider Demographics
NPI:1548756794
Name:HUSEMANN, DUSTIN RICHARD (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RICHARD
Last Name:HUSEMANN
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 CASHEL DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-7900
Mailing Address - Country:US
Mailing Address - Phone:503-866-3772
Mailing Address - Fax:
Practice Address - Street 1:16601 N 40TH ST STE 227
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3354
Practice Address - Country:US
Practice Address - Phone:602-633-3722
Practice Address - Fax:602-595-1127
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11403363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care