Provider Demographics
NPI:1811609613
Name:FUSSI, DEANNA (FNP STUDENT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:FUSSI
Suffix:
Gender:F
Credentials:FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 MONTVALE ST
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:VA
Mailing Address - Zip Code:24122-2510
Mailing Address - Country:US
Mailing Address - Phone:540-875-9594
Mailing Address - Fax:
Practice Address - Street 1:1423 MONTVALE ST
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:VA
Practice Address - Zip Code:24122-2510
Practice Address - Country:US
Practice Address - Phone:540-875-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001254768390200000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001254768OtherLICENSE