MEDICARE: MS. MICHELLE MAXINE BUSSE R.N.

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	163W00000X	Registered Nurse	167695-30	WI

General Provider Information

NPI Number	:	1336375773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MAXINE BUSSE R.N.

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:	410 FOREST HOME DRIVE
City	:	FRANCIS CREEK
State	:	WI
Zip	:	54214-0126
Country	:	US
Telephone Number	:	920-360-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 FOREST HOME DRIVE
Second Line	:
City	:	FRANCIS CREEK
State	:	WI
Zip	:	54214-0126
Country	:	US
Telephone Number	:	920-360-6778
Fax Number	:

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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