Healthcare Provider Details

I. General information

NPI: 1639151178
Provider Name (Legal Business Name): WANELL (NELL) STELLA BUSEY CST/CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: WANELL (NELL) STELLA CIRLING CST/CFA

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N ARLINGTON AVE
RENO NV
89503-4724
US

IV. Provider business mailing address

555 N ARLINGTON AVE
RENO NV
89503-4724
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-3040
  • Fax: 775-786-1358
Mailing address:
  • Phone: 775-786-3040
  • Fax: 775-786-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number96-0577
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: