Individual
MRS. KAREN M BUSSONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614
(309) 691-4410
(309) 589-2830
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614
(309) 691-4410
(309) 589-2830
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209000600
IL
363LA2100X
Acute Care Nurse Practitioner
209000600
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209000600
—
IL
Enumeration date
08/01/2006
Last updated
08/26/2010
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