Provider Demographics
NPI:1730076787
Name:BUSCH, STACIE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LYNN
Last Name:BUSCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPN
Mailing Address - Street 1:2517 SOUTH 167TH AVENUE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1503
Mailing Address - Country:US
Mailing Address - Phone:402-651-5927
Mailing Address - Fax:
Practice Address - Street 1:6312 S 167TH S. AVE
Practice Address - Street 2:6312 S. 167TH AVE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135
Practice Address - Country:US
Practice Address - Phone:402-630-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse