MEDICARE: NANCY M HUSSAR LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024171389	OTHER	VA	STATE LICENSE

General Provider Information

NPI Number	:	1295392389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY M HUSSAR LLC

Provider Business Mailing Address
First Line	:	4444 GERMANNA HWY STE 330
Second Line	:
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2044
Country	:	US
Telephone Number	:	540-755-7157
Fax Number	:	540-755-2846

Provider Business Practice Location Address
First Line	:	4444 GERMANNA HWY STE 330
Second Line	:
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2044
Country	:	US
Telephone Number	:	540-755-7157
Fax Number	:	540-755-2846

Authorized Official
Title or Position	:	OWNER
Name	:	NANCY M HUSSAR
Credential	:	MSN
Telephone Number	:	540-755-7157

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	05/24/2019

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