Provider Demographics
NPI:1336474352
Name:BUSANO, DOLORES (RN)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:BUSANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:EVE
Other - Last Name:MARCELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-804-3691
Mailing Address - Fax:512-483-5820
Practice Address - Street 1:5225 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1820
Practice Address - Country:US
Practice Address - Phone:512-804-3691
Practice Address - Fax:512-483-5820
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse