Provider Demographics
NPI:1922665348
Name:VANBUSKIRK, MARCIA L
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:L
Other - Last Name:VANBUSKIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:353 CUSHING RD
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:ME
Mailing Address - Zip Code:04563-3118
Mailing Address - Country:US
Mailing Address - Phone:207-354-5429
Mailing Address - Fax:207-354-5429
Practice Address - Street 1:353 CUSHING RD
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:ME
Practice Address - Zip Code:04563-3118
Practice Address - Country:US
Practice Address - Phone:207-354-5429
Practice Address - Fax:207-354-5429
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1114576980376J00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1114576980OtherVETERANS ADMINISTRATION
ME1114576980Medicaid