Healthcare Provider Details

I. General information

NPI: 1720337694
Provider Name (Legal Business Name): JESSICA GUSA GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZHONGHUA XIE

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2426
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209528-8
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4932-33
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2426
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: