Provider Demographics
NPI:1184173825
Name:ELIZABETH BUSETTO ND LLC
Entity type:Organization
Organization Name:ELIZABETH BUSETTO ND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSETTO
Authorized Official - Suffix:
Authorized Official - Credentials:ND, DC, IBCLC
Authorized Official - Phone:503-954-3676
Mailing Address - Street 1:819 SE MORRISON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-6312
Mailing Address - Country:US
Mailing Address - Phone:503-954-3676
Mailing Address - Fax:503-954-3776
Practice Address - Street 1:819 SE MORRISON ST STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6312
Practice Address - Country:US
Practice Address - Phone:503-954-3676
Practice Address - Fax:503-954-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1585261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care