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NPI Code Detail

MEDICARE: NICOLE MARIE BUSSERT LADC

MEDICARE: NICOLE MARIE BUSSERT LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor303446MN

Other Identifiers

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

General Provider Information

NPI Number : 1548638851
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE BUSSERT LADC
Provider Business Mailing Address
First Line : 410 HAYWARD AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-5379
Country : US
Telephone Number : 651-777-4233
Fax Number : 651-777-3507
Provider Business Practice Location Address
First Line : 410 HAYWARD AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-5379
Country : US
Telephone Number : 651-777-4233
Fax Number : 651-777-3507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2015
Last Update Date : 09/03/2015

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Directions to “ NICOLE MARIE BUSSERT LADC” Practice Location

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