Provider Demographics
NPI:1689290777
Name:HUSACK, ANSLEY
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:
Last Name:HUSACK
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 1:1169 WINGATE DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3921
Mailing Address - Country:US
Mailing Address - Phone:404-291-0554
Mailing Address - Fax:
Practice Address - Street 1:1169 WINGATE DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3921
Practice Address - Country:US
Practice Address - Phone:404-291-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty