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General NPI Number Information
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NPI Number | 1336375773
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Entity Type | Individual
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Provider Name | MICHELLE MAXINE BUSSE R.N.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 410 FOREST HOME DRIVE
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City | FRANCIS CREEK
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State | WI
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Zip | 54214-0126
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Country | US
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Telephone | 920-360-6778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 126 410 FOREST HOME DRIVE
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City | FRANCIS CREEK
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State | WI
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Zip | 54214-0126
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Country | US
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Telephone | 920-360-6778
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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 | 167695-30
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License Number State | WI
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