Healthcare Provider Details

I. General information

NPI: 1588780068
Provider Name (Legal Business Name): MARLENE GRACE BUSKIRK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2447
US

IV. Provider business mailing address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2447
US

V. Phone/Fax

Practice location:
  • Phone: 612-436-0295
  • Fax:
Mailing address:
  • Phone: 612-436-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR 043034-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: