MEDICARE: JEFFREY GUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A131955	IA

General Provider Information

NPI Number	:	1063827798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GUSE

Provider Business Mailing Address
First Line	:	4222 CARLTON DR
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7541
Country	:	US
Telephone Number	:	515-240-3009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 W RIDGEWAY AVE
Second Line	:	SUITE 100
City	:	WATERLOO
State	:	IA
Zip	:	50701-4595
Country	:	US
Telephone Number	:	319-833-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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