=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568791408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA PRICE BUSS CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2009
-----------------------------------------------------
Last Update Date | 06/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616 W MAIN ST SUITE 508
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62959-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-499-0562
-----------------------------------------------------
Fax | 618-997-1122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 GOOD SAMARITAN WAY STE 205
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-899-3869
-----------------------------------------------------
Fax | 618-899-3558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 156892
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 209009326
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------