Provider Demographics
NPI:1447801550
Name:BUSMIRE, KAREN IRENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:IRENE
Last Name:BUSMIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:IRENE
Other - Last Name:KEEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1141 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3208
Mailing Address - Country:US
Mailing Address - Phone:760-463-2880
Mailing Address - Fax:760-446-0298
Practice Address - Street 1:1141 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3208
Practice Address - Country:US
Practice Address - Phone:760-463-2880
Practice Address - Fax:760-446-0298
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0270433Medicaid