MEDICARE: EMILY ANNE NUSSBAUM APRN CNP

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.0033796	OH

General Provider Information

NPI Number	:	1306520408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANNE NUSSBAUM APRN CNP

Provider Business Mailing Address
First Line	:	809 COSHOCTON AVE STE C
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1900
Country	:	US
Telephone Number	:	740-948-8369
Fax Number	:	855-631-0107

Provider Business Practice Location Address
First Line	:	809 COSHOCTON AVE STE C
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1900
Country	:	US
Telephone Number	:	740-948-8369
Fax Number	:	855-631-0107

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	01/09/2026

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