Basic Information
| Provider Information | |||||||||
| NPI: | 1497355218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBUSCA | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2673 DAVISSON RUN RD | ||||||||
| Address2: | STE 303 | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005414009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 327 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263309006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813421000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 85837 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.