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General NPI Number Information
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NPI Number | 1063678167
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Entity Type | Individual
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Provider Name | MRS. LISA MARIE BUSCH
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Gender | Female
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 103 W US HIGHWAY 2
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City | WAKEFIELD
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State | MI
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Zip | 49968-9515
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Country | US
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Telephone | 906-229-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 103 W US HIGHWAY 2
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City | WAKEFIELD
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State | MI
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Zip | 49968-9515
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Country | US
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Telephone | 906-229-6120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704255158
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 163642030
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 4704255158
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License Number State | MI
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