Provider Demographics
NPI:1629660790
Name:SLUSS, EMILY MARIE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:SLUSS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 BOAT CLUB RD STE 257
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7023
Mailing Address - Country:US
Mailing Address - Phone:817-346-6464
Mailing Address - Fax:817-238-0054
Practice Address - Street 1:4625 BOAT CLUB RD STE 257
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7023
Practice Address - Country:US
Practice Address - Phone:817-346-6464
Practice Address - Fax:817-238-0054
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX891413207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery