Provider Demographics
NPI:1326245952
Name:BUYESKE, KATHRYN A (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:BUYESKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-1244
Mailing Address - Country:US
Mailing Address - Phone:920-901-1099
Mailing Address - Fax:
Practice Address - Street 1:216 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4636
Practice Address - Country:US
Practice Address - Phone:800-246-5743
Practice Address - Fax:715-675-5475
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI830-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43836700Medicaid
WIBUY104288554OtherNCC CERTIFICATE