Provider Demographics
NPI:1689364614
Name:NAUSS, PETER ANTHONY
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:NAUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 APPLE DR SE
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-5313
Mailing Address - Country:US
Mailing Address - Phone:276-393-1997
Mailing Address - Fax:
Practice Address - Street 1:219 APPLE DR SE
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-5313
Practice Address - Country:US
Practice Address - Phone:276-393-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant