Individual
MRS. BELLE NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9255 E LOY LN, CORNVILLE, AZ 86325
(928) 649-8180
Mailing address
PO BOX 393, CORNVILLE, AZ 86325-0393
(928) 649-8180
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
097321
AHCCCS
AZ
Enumeration date
12/11/2006
Last updated
07/08/2007
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