Julie R Bussewitz, O.T.
Individual provider Active NPI Specialist · Gallup, NM
NPI 1679604342 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679604342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 599 (NM)
- Practice address
- 700 S Boardman Ave
Gallup, NM 87301-4707 - Phone
- (505) 721-1172
- NPI assigned
- Mar 7, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 599 | NM | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gallup McKinley County Schools | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 599 | NM | Yes |
Addresses
Primary practice location
700 S Boardman Ave
Gallup, NM 87301-4707
Mailing address
1612 Monterey Dr
Gallup, NM 87301-5640
Phone (505) 721-1172
Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.