Individual
MARY NUSSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
550 MUNSON AVE STE 200, TRAVERSE CITY, MI 49686-3580
(231) 935-8717
(231) 935-9230
Mailing address
550 MUNSON AVE STE 200, TRAVERSE CITY, MI 49686-3580
(319) 358-7172
(231) 935-9230
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
NE
Enumeration date
07/14/2022
Last updated
04/03/2024
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