Active NPI
Terrance Kusserow, RNWCC
- Wound Care Registered Nurse
- Santo Domingo Pueblo, NM
National Provider Identifier
1346606753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Wound Care Registered Nurse
- License
- R52166
- Practice address
- 85 West Highway 22
Santo Domingo Pueblo, NM 87052 - Phone
- (505) 465-3060
- NPI assigned
- Jan 14, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Wound Care Registered Nurse | 163WW0000X | R52166 | NM | Primary |
Addresses
Primary practice location
85 West Highway 22
Santo Domingo Pueblo, NM 87052
Mailing address
85 West Highway 22
Santo Domingo Pueblo, NM 87052
Phone (505) 465-3060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R52166 | NM | MD | Wound Care Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452729600000",
"number": "1346606753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 WEST HIGHWAY 22",
"city": "SANTO DOMINGO PUEBLO",
"state": "NM",
"postal_code": "87052",
"telephone_number": "505-465-3060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 WEST HIGHWAY 22",
"city": "SANTO DOMINGO PUEBLO",
"state": "NM",
"postal_code": "87052",
"telephone_number": "505-465-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUSSEROW",
"first_name": "TERRANCE",
"credential": "RNWCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-14",
"last_updated": "2016-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "163WW0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Wound Care",
"state": "NM",
"license": "R52166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santo Domingo Pueblo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.