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General NPI Number Information
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NPI Number | 1306266614
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Entity Type | Organization
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Legal Business Name | PRISM HEALTH CARE, PLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 1045 TACOMA AVE APT 118
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City | BISMARCK
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State | ND
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Zip | 58504
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Country | US
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Telephone | 248-756-6025
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Fax | 248-458-4154
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Provider Business Mailing Address
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Address Line | 220 E ROSSER AVE UNIT 544
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City | BISMARCK
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State | ND
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Zip | 58502-6656
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Country | US
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Telephone | 248-756-6025
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Fax | 248-458-4154
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Authorized Official
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Title or Position | OWNER
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Name | LYNETTE M GUSS
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Credential | NP
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Telephone | 248-756-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704218575
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License Number State | MI
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