Healthcare Provider Details

I. General information

NPI: 1104105691
Provider Name (Legal Business Name): STEPHANIE MARIE BUSSMANN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 04/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST SUITE4B
NEW YORK NY
10019-8022
US

IV. Provider business mailing address

425 W 59TH ST SUITE4B
NEW YORK NY
10019-8022
US

V. Phone/Fax

Practice location:
  • Phone: 212-581-8675
  • Fax: 212-459-9113
Mailing address:
  • Phone: 212-581-8675
  • Fax: 212-459-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1957
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNMW1957
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: