Provider Demographics
NPI:1134550072
Name:NUSZ, BRENDA (LPN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:NUSZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 JACQUALYN DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4134
Mailing Address - Country:US
Mailing Address - Phone:810-338-5341
Mailing Address - Fax:
Practice Address - Street 1:288 JACQUALYN DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4134
Practice Address - Country:US
Practice Address - Phone:810-338-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703089631164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703089631OtherSTATE LICENSE