Provider Demographics
NPI:1710243563
Name:BUSALACCHI, ANGELA JOANNE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOANNE
Last Name:BUSALACCHI
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 1:1321 S 114TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2235
Mailing Address - Country:US
Mailing Address - Phone:414-426-6452
Mailing Address - Fax:
Practice Address - Street 1:1321 S 114TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2235
Practice Address - Country:US
Practice Address - Phone:414-426-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177987-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse