Individual
MRS. LISA MARIE BUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 W US HIGHWAY 2, WAKEFIELD, MI 49968-9515
(906) 229-6120
Mailing address
103 W US HIGHWAY 2, WAKEFIELD, MI 49968-9515
(906) 229-6120
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
163642030
WI
163W00000X
Registered Nurse
4704255158
MI
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704255158
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35066500
—
WI
Enumeration date
07/29/2008
Last updated
05/08/2018
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