Provider Demographics
NPI:1417739707
Name:BUSA, MARYBETH MARION (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:MARION
Last Name:BUSA
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 1:7 CARTER LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2609
Mailing Address - Country:US
Mailing Address - Phone:781-405-0035
Mailing Address - Fax:
Practice Address - Street 1:1 GRIFFIN BROOK DR
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1865
Practice Address - Country:US
Practice Address - Phone:978-689-6573
Practice Address - Fax:978-681-0459
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328419163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health