Healthcare Provider Details

I. General information

NPI: 1275353468
Provider Name (Legal Business Name): AURORA ASHLYN BUSCHKAMP ATC, LAT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 CHAVENELLE RD
DUBUQUE IA
52002-2616
US

IV. Provider business mailing address

1565 FAIRFAX AVE
DUBUQUE IA
52001-5448
US

V. Phone/Fax

Practice location:
  • Phone: 563-556-4050
  • Fax:
Mailing address:
  • Phone: 712-229-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number001195
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: