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General NPI Number Information
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NPI Number | 1457646473
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Entity Type | Individual
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Provider Name | STEPHANIE LYN BUSCH RN
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Gender | Female
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | JCT. US HWY 160 & NAVAJO ROUTE 35 - RED MESA FOUR CORNERS REGIONAL HEALTH CENTER
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City | TEEC NOS POS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5000
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Fax | 928-656-5164
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Provider Business Mailing Address
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Address Line | BOX 30 FOUR CORNERS REGINAL HEALTH CENTER, HCR 6100
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City | TEEC NOS POS
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State | AZ
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Zip | 86514
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Country | US
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Telephone | 928-656-5000
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Fax | 928-656-5164
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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 | 289195-3102
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License Number State | UT
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