Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Nussbaum

Individual provider Physician Assistant · NPI 1396479440

Mary Nussbaum is a Physician Assistant in Traverse City, Michigan. Graduated from Nebraska College of Medicine in 2023, 3 years ago. Practices as a sole proprietor and works from 2 locations.

Years since qualifying
3
Trained at
Nebraska College of Medicine
In the registry since
2022
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Practice location Address checks out

550 Munson Ave Ste 200
Traverse City, MI 49686-3580
Phone: (231) 935-8717
Fax: (231) 935-9230
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2326 S 118th Ct, Omaha, NE 68144-2928 — (402) 612-9566

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1396479440
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 14, 2022
Last updated in NPPESApril 3, 2024
Certification dateApril 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolNEBRASKA COLLEGE OF MEDICINE
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated

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