Healthcare Provider Details

I. General information

NPI: 1184630741
Provider Name (Legal Business Name): NANETTE S. NUESSLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANETTE S GILPIN M.D.

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD BLDG 1130
GLENDALE AZ
85309
US

IV. Provider business mailing address

11630 N REEMS RD #2051
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-4029
  • Fax:
Mailing address:
  • Phone: 913-948-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-34846
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-087877
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: