Provider Demographics
NPI:1144063959
Name:NUSTA, EMMANUEL ESOKA (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ESOKA
Last Name:NUSTA
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 LOCKMAN LN
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-6310
Mailing Address - Country:US
Mailing Address - Phone:240-601-8517
Mailing Address - Fax:
Practice Address - Street 1:7511 LOCKMAN LN
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-6310
Practice Address - Country:US
Practice Address - Phone:240-601-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR179880363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health