Healthcare Provider Details

I. General information

NPI: 1881721934
Provider Name (Legal Business Name): SANDRA KAY BUSEMAN MD MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-5925
  • Fax:
Mailing address:
  • Phone: 360-619-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDR.0036588
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDR.0036588
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberDR.0036588
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDR.0036588
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: