Provider Demographics
NPI:1942308499
Name:NUSSBAUM, NANCY L (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:BLDG. F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-637-5894
Mailing Address - Fax:512-452-5567
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:BLDG. F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-637-5894
Practice Address - Fax:512-452-5567
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2 3369103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR59868Medicare UPIN
TX80007P2Medicare ID - Type Unspecified