Provider Demographics
NPI:1457522526
Name:NUSSMAN, KATRINA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:NUSSMAN
Suffix:
Gender:F
Credentials:RN, BSN
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 104
Mailing Address - Street 2:
Mailing Address - City:DEADWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97430-0104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91955 DEADWOOD CREEK RD
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:OR
Practice Address - Zip Code:97430-9704
Practice Address - Country:US
Practice Address - Phone:541-525-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR98000486RN101YP2500X
OR098000486RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional