Provider Demographics
NPI:1841900354
Name:RUSNAK, ANN MARIE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MRS
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:MCGOWAN RUSNAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:103 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18407-3702
Mailing Address - Country:US
Mailing Address - Phone:570-840-3169
Mailing Address - Fax:
Practice Address - Street 1:103 AMELIA AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18407-3702
Practice Address - Country:US
Practice Address - Phone:570-840-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO27128363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology