Provider Demographics
NPI:1568963114
Name:BUSBEY, JENNIFER (BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUSBEY
Suffix:
Gender:F
Credentials:BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7721
Mailing Address - Country:US
Mailing Address - Phone:301-219-2761
Mailing Address - Fax:
Practice Address - Street 1:19801 OBSERVATION DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4070
Practice Address - Country:US
Practice Address - Phone:301-557-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-46767163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant