Provider Demographics
NPI:1275307092
Name:BUSANO, GRACE LYNN
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LYNN
Last Name:BUSANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3731
Mailing Address - Country:US
Mailing Address - Phone:702-776-4841
Mailing Address - Fax:
Practice Address - Street 1:2500 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3731
Practice Address - Country:US
Practice Address - Phone:702-776-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator