Provider Demographics
NPI:1952505042
Name:NUSSBAUM, JOANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HETTYS PATH
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1367
Mailing Address - Country:US
Mailing Address - Phone:631-732-5527
Mailing Address - Fax:
Practice Address - Street 1:379 MOONEY POND RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3416
Practice Address - Country:US
Practice Address - Phone:631-696-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335805-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics