Healthcare Provider Details

I. General information

NPI: 1275805533
Provider Name (Legal Business Name): HANNAH MARIE NUSZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CANDELARIA DRIVE
IGNACIO CO
81137-0800
US

IV. Provider business mailing address

281 SILVER QUEEN S UNIT 110B
DURANGO CO
81301-9433
US

V. Phone/Fax

Practice location:
  • Phone: 970-563-4517
  • Fax:
Mailing address:
  • Phone: 913-205-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: