Provider Demographics
NPI:1417468091
Name:BUSE, AMANDA (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BUSE
Suffix:
Gender:F
Credentials:FNP
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 181
Mailing Address - Street 2:
Mailing Address - City:WALL LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51466-0181
Mailing Address - Country:US
Mailing Address - Phone:712-664-2418
Mailing Address - Fax:949-655-8648
Practice Address - Street 1:210 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WALL LAKE
Practice Address - State:IA
Practice Address - Zip Code:51466-7726
Practice Address - Country:US
Practice Address - Phone:712-664-2418
Practice Address - Fax:949-655-8648
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA130853363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care