Healthcare Provider Details

I. General information

NPI: 1629161310
Provider Name (Legal Business Name): SCOTT T BUSKERUD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/24/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5702
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-7719
  • Fax:
Mailing address:
  • Phone: 715-387-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1369
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: