Individual
JESSICA NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6812 STATE ROUTE 162 STE 120, MARYVILLE, IL 62062-8586
(618) 288-0044
Mailing address
8333 GOSHEN RD, EDWARDSVILLE, IL 62025-6908
(309) 310-7824
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085.009880
IL
Other
Enumeration date
08/04/2023
Last updated
08/04/2023
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