Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 3006730 | KY |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 775117 | TX |
NPI | 1265763361 |
---|---|
Provider Name | Heather Ann Gusic |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2010 |
Last Update Date | 19/10/2020 |