Healthcare Provider Details

I. General information

NPI: 1902732696
Provider Name (Legal Business Name): TANNER BUSACKER NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62980 BOYD ACRES RD
BEND OR
97701-8289
US

IV. Provider business mailing address

4107 E OVERLAND RD UNIT B202
MERIDIAN ID
83642-8400
US

V. Phone/Fax

Practice location:
  • Phone: 541-639-9993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number82953
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number83032
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberAZ00013748
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number22508036
License Number StateAK
# 5
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number210241
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: