Healthcare Provider Details

I. General information

NPI: 1336057751
Provider Name (Legal Business Name): MARYSSA GUSSERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E H ST
IRON MOUNTAIN MI
49801-4756
US

IV. Provider business mailing address

210 E H ST
IRON MOUNTAIN MI
49801-4756
US

V. Phone/Fax

Practice location:
  • Phone: 906-779-4327
  • Fax:
Mailing address:
  • Phone: 906-779-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2218-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: