MEDICARE: MS. ANNE M. BASSUK FNP-C

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	0024167525	VA

General Provider Information

NPI Number	:	1639162738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE M. BASSUK FNP-C

Provider Business Mailing Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5112
Fax Number	:	804-675-5390

Provider Business Practice Location Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5112
Fax Number	:	804-675-5390

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	11/13/2024

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