Gary Wilson Barsuaskas, NP

Individual provider Active NPI Adult Health Nurse Practitioner · Arcata, CA

NPI 1194089805 · NPPES record last updated Jul 5, 2012

Key facts

NPI
1194089805
Entity type
Individual (NPI type 1)
Primary specialty
Adult Health Nurse Practitioner 363LA2200X
License
582770/12889 (CA)
Practice address
4677 Valley West Blvd.
Arcata, CA 95521
Phone
(707) 822-5244
Fax
(707) 822-5442
NPI assigned
Jun 27, 2012
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
582770/12889CAMDAdult Health Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Health Nurse Practitioner 363LX0106X 582770/12889 CA
Adult Health Nurse Practitioner 363LA2200X 582770/12889 CA Yes

Addresses

Primary practice location

4677 Valley West Blvd.
Arcata, CA 95521

Mailing address

PO Box 362
Cutten, CA 95534
Phone (707) 616-9086

Other providers in Arcata, CA

All providers in Arcata, CA · Adult Health Nurse Practitioner in California

Sources for this page

Verify at the official NPI Registry.