Healthcare Provider Details

I. General information

NPI: 1942308499
Provider Name (Legal Business Name): NANCY L NUSSBAUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST BLDG. F
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

711 W 38TH ST BLDG. F
AUSTIN TX
78705-1121
US

V. Phone/Fax

Practice location:
  • Phone: 512-637-5894
  • Fax: 512-452-5567
Mailing address:
  • Phone: 512-637-5894
  • Fax: 512-452-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2 3369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: