Provider Demographics
NPI:1124216296
Name:BUSSENIUS, HOPE VICTORIA (RN, MN, FNP-C)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:VICTORIA
Last Name:BUSSENIUS
Suffix:
Gender:F
Credentials:RN, MN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BUCK TRL
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2189
Mailing Address - Country:US
Mailing Address - Phone:706-367-7302
Mailing Address - Fax:
Practice Address - Street 1:657 ATHENS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1474
Practice Address - Country:US
Practice Address - Phone:706-367-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR100015363LA2200X, 363LF0000X, 363LP2300X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85001597GMedicaid
GA85001597GMedicaid