Provider Demographics
NPI:1487768735
Name:NUESSLE, DONALD W (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:NUESSLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1029 W MAIN ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3351
Mailing Address - Country:US
Mailing Address - Phone:615-443-1252
Mailing Address - Fax:615-453-1286
Practice Address - Street 1:1029 W MAIN ST
Practice Address - Street 2:SUITE M
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3351
Practice Address - Country:US
Practice Address - Phone:615-453-1252
Practice Address - Fax:615-453-1286
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN23546207P00000X
TNMD23546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3072246Medicaid
TN3072246Medicaid
E11888Medicare UPIN