Provider Demographics
NPI:1588616023
Name:DUSEK, NANCY EILEEN (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:EILEEN
Last Name:DUSEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-769-4500
Practice Address - Fax:865-769-4501
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN079271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0150OtherJOHN DEERE HEALTHCARE
TNP00052149OtherRAILROAD MEDICARE
TN1518119Medicaid
1024253OtherCIGNA
TN3141142OtherBLUECROSS BLUESHIELD
TNTN0105OtherJOHN DEERE HEALTHCARE
TNTN0118OtherJOHN DEERE HEALTHCARE
TNTN0105OtherJOHN DEERE HEALTHCARE
S54036Medicare UPIN
TN103I506644Medicare PIN
TNP00052149OtherRAILROAD MEDICARE
TN3141142OtherBLUECROSS BLUESHIELD