Provider Demographics
NPI:1275782393
Name:BUSS, PAMELA A (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BUSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:221 EAST BLUFF STREET
Mailing Address - City:CASSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53806-0308
Mailing Address - Country:US
Mailing Address - Phone:608-725-5091
Mailing Address - Fax:
Practice Address - Street 1:221 E BLUFF ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53806
Practice Address - Country:US
Practice Address - Phone:608-725-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165186-030163W00000X
WI307841-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35066800Medicaid
WI6253727OtherMEDICAID PA NUMBER