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General NPI Number Information
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NPI Number | 1336229251
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Entity Type | Individual
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Provider Name | DALE RAY BUISMAN NEONATAL NURSE PRACT
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 201 E NICOLLET BLVD
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City | BURNSVILLE
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State | MN
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Zip | 55337-5714
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Country | US
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Telephone | 952-892-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 38265 GREAT OAKS COURT
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City | NORTH BRANCH
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State | MN
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Zip | 55056-3321
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Country | US
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Telephone | 952-892-2360
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | R1465136
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | R-146513-6
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License Number State | MN
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