Provider Demographics
NPI:1437601044
Name:BUSCH, ELIZABETH KATHLEEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:KATHLEEN
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2112 CASE PKWY
Mailing Address - Street 2:#10
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-4301
Mailing Address - Country:US
Mailing Address - Phone:330-425-8474
Mailing Address - Fax:330-425-2905
Practice Address - Street 1:2112 CASE PKWY
Practice Address - Street 2:#10
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4301
Practice Address - Country:US
Practice Address - Phone:330-425-8474
Practice Address - Fax:330-425-2905
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118953164W00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse