Provider Demographics
NPI:1639247323
Name:GUSS, LYNETTE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:GUSS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E ROSSER AVE UNIT 544
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-6656
Mailing Address - Country:US
Mailing Address - Phone:248-756-6025
Mailing Address - Fax:248-458-4154
Practice Address - Street 1:26200 FORD RD UNIT 95
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4304
Practice Address - Country:US
Practice Address - Phone:248-756-6025
Practice Address - Fax:248-458-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7661001OtherMEDICARE PTAN
MI0N82770Medicare ID - Type Unspecified