Provider Demographics
NPI:1881859254
Name:BUSSE, KJERSTEN L (NP)
Entity Type:Individual
Prefix:
First Name:KJERSTEN
Middle Name:L
Last Name:BUSSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5249 E TERRACE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8339
Practice Address - Country:US
Practice Address - Phone:608-265-1290
Practice Address - Fax:608-264-4646
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI123096363L00000X
WI3179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner