Provider Demographics
NPI:1376691600
Name:REIF-BUSMAN, CARRIE E (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:E
Last Name:REIF-BUSMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:E
Other - Last Name:REIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-753-8453
Mailing Address - Fax:989-753-3519
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3349
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700G360400OtherBX
MIMI5159007Medicare PIN
MI0P03290Medicare PIN