Healthcare Provider Details

I. General information

NPI: 1508398397
Provider Name (Legal Business Name): MICHELLE BUSCEMI APN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 224-251-2374
  • Fax: 847-933-3531
Mailing address:
  • Phone: 224-251-2374
  • Fax: 847-933-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209015456
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041313664
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: