Healthcare Provider Details

I. General information

NPI: 1922665348
Provider Name (Legal Business Name): MARCIA L VANBUSKIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA L VANBUSKIRK

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 CUSHING RD
CUSHING ME
04563-3118
US

IV. Provider business mailing address

353 CUSHING RD
CUSHING ME
04563-3118
US

V. Phone/Fax

Practice location:
  • Phone: 207-354-5429
  • Fax: 207-354-5429
Mailing address:
  • Phone: 207-354-5429
  • Fax: 207-354-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1114576980
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: