Provider Demographics
NPI:1568791408
Name:BUSS, ANGELA PRICE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PRICE
Last Name:BUSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GOOD SAMARITAN WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2476
Mailing Address - Country:US
Mailing Address - Phone:618-899-3869
Mailing Address - Fax:618-899-3558
Practice Address - Street 1:1616 W MAIN ST
Practice Address - Street 2:SUITE 508
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1146
Practice Address - Country:US
Practice Address - Phone:618-499-0562
Practice Address - Fax:618-997-1122
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN156892367500000X
IL209009326367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered