Provider Demographics
NPI:1811186232
Name:BUESCHEN-MONAHAN, ELISABETH
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:BUESCHEN-MONAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54655 NW OLD WILSON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GALES CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97117-9327
Mailing Address - Country:US
Mailing Address - Phone:503-784-4812
Mailing Address - Fax:
Practice Address - Street 1:54655 NW OLD WILSON RIVER RD
Practice Address - Street 2:
Practice Address - City:GALES CREEK
Practice Address - State:OR
Practice Address - Zip Code:97117-9327
Practice Address - Country:US
Practice Address - Phone:503-784-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN170738164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse