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General NPI Number Information
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NPI Number | 1235955055
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH BUSACCO APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2222 W IOWA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2738
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Country | US
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Telephone | 405-756-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 916 N 6TH AVE
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City | PURCELL
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State | OK
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Zip | 73080-2207
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Country | US
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Telephone | 405-637-5625
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 221033
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License Number State | OK
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