Provider Demographics
NPI:1417487265
Name:BUSCH, MELISSA ASHLEY (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ASHLEY
Last Name:BUSCH
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 1:4008 FAUROT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0312
Mailing Address - Country:US
Mailing Address - Phone:217-725-8787
Mailing Address - Fax:
Practice Address - Street 1:4812 SANTANA CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7138
Practice Address - Country:US
Practice Address - Phone:217-725-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse