Healthcare Provider Details

I. General information

NPI: 1033234570
Provider Name (Legal Business Name): GENE PAUL NUSE APRN BC FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MARKET ST
GLASGOW MO
65254-1053
US

IV. Provider business mailing address

17651 B HWY
BOONVILLE MO
65233-2839
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-7461
  • Fax:
Mailing address:
  • Phone: 660-882-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number101440
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101440
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: