Provider Demographics
NPI:1568221323
Name:TUSSE, DURETI DUBE
Entity Type:Individual
Prefix:
First Name:DURETI
Middle Name:DUBE
Last Name:TUSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ROLLING HILLS AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2899
Mailing Address - Country:US
Mailing Address - Phone:503-317-9201
Mailing Address - Fax:971-273-0825
Practice Address - Street 1:117 ROLLING HILLS AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2899
Practice Address - Country:US
Practice Address - Phone:503-317-9201
Practice Address - Fax:971-273-0825
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR527152311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home