Healthcare Provider Details

I. General information

NPI: 1417468091
Provider Name (Legal Business Name): AMANDA BUSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 1ST ST
WALL LAKE IA
51466-7726
US

IV. Provider business mailing address

1160 3RD ST
LAKE VIEW IA
51450-7612
US

V. Phone/Fax

Practice location:
  • Phone: 712-664-2418
  • Fax: 949-655-8648
Mailing address:
  • Phone: 712-665-8555
  • Fax: 712-464-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA130853
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA130853
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: