Healthcare Provider Details

I. General information

NPI: 1255828638
Provider Name (Legal Business Name): ERIKA BEUSSINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

1911 WILLIAMSBURG DR
CAPE GIRARDEAU MO
63701-4576
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-4822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2018013320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: