MEDICARE: DEBRA NUSSBAUM

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	163W00000X	Registered Nurse	376171	CA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1689868556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA NUSSBAUM

Provider Business Mailing Address
First Line	:	7001A EAST PKWY
Second Line	:	SUITE 600
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9719 LINCOLN VILLAGE DR
Second Line	:	SUITE 605
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-3303
Country	:	US
Telephone Number	:	916-875-5000
Fax Number	:

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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Directions to “ DEBRA NUSSBAUM ” Practice Location

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