MEDICARE: BRADLEY K BUSEY II FNPC

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	363LP2300X	Primary Care Nurse Practitioner	201707058NP-PP	OR
2	363LF0000X	Family Nurse Practitioner	201707058NP-PP	OR

General Provider Information

NPI Number	:	1720537814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY K BUSEY II FNPC

Provider Business Mailing Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:

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

Provider Enumeration Date	:	09/29/2016
Last Update Date	:	11/21/2023

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