Provider Demographics
NPI:1790115996
Name:NALLUSAMY, VASUMATHI (MSN)
Entity Type:Individual
Prefix:MRS
First Name:VASUMATHI
Middle Name:
Last Name:NALLUSAMY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:VASU
Other - Middle Name:
Other - Last Name:NALLUSAMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN
Mailing Address - Street 1:1858 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-4573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8225 FLYING CLOUD DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5315
Practice Address - Country:US
Practice Address - Phone:952-944-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 200255-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily