Provider Demographics
NPI:1992865083
Name:NUSSBAUM, BELLE
Entity Type:Individual
Prefix:MRS
First Name:BELLE
Middle Name:
Last Name:NUSSBAUM
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:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-0393
Mailing Address - Country:US
Mailing Address - Phone:928-649-8180
Mailing Address - Fax:
Practice Address - Street 1:9255 E LOY LN
Practice Address - Street 2:
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325
Practice Address - Country:US
Practice Address - Phone:928-649-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ097321OtherAHCCCS