MEDICARE: MS. MARY DENISE BUSCH PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	097006687N6PMHNP-PP	OR
2	363LF0000X	Family Nurse Practitioner	201050124NP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235219726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY DENISE BUSCH PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 6149
Second Line	:
City	:	ALOHA
State	:	OR
Zip	:	97007-0149
Country	:	US
Telephone Number	:	503-352-8642
Fax Number	:	503-352-8658

Provider Business Practice Location Address
First Line	:	226 SE 8TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4218
Country	:	US
Telephone Number	:	503-601-7400
Fax Number	:	503-601-7311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/15/2019

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