Provider Demographics
NPI:1740413806
Name:NUSSBAUM, DAFNA Y (MA IN SPECIAL ED)
Entity type:Individual
Prefix:MS
First Name:DAFNA
Middle Name:Y
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MA IN SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 BRUMMEL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5116
Mailing Address - Country:US
Mailing Address - Phone:773-715-1110
Mailing Address - Fax:
Practice Address - Street 1:931 BRUMMEL ST APT 1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-5116
Practice Address - Country:US
Practice Address - Phone:773-715-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist