MEDICARE: GAYETTE LYN HUSEBY NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0002X	Neonatal Intensive Care Registered Nurse	560878	TX
2	363LN0000X	Neonatal Nurse Practitioner	AP113437	TX

General Provider Information

NPI Number	:	1093777831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYETTE LYN HUSEBY NNP

Provider Business Mailing Address
First Line	:	4025 LITTLE LN
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-1913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N OREGON ST
Second Line	:	SUITE 312
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-542-0739
Fax Number	:	915-542-0744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	11/14/2019

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