Provider Demographics
NPI:1063813525
Name:BUSBY, COLLEEN (LPN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BUSBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8369 FLORIDA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7862
Mailing Address - Country:US
Mailing Address - Phone:225-665-5149
Mailing Address - Fax:225-667-1770
Practice Address - Street 1:8369 FLORIDA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-665-5149
Practice Address - Fax:225-667-1770
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA980979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA980979OtherNURSE LIC