Provider Demographics
NPI:1205156635
Name:BUSCH, SUSAN PATRICIA (RN, LCCE, CD(DONA))
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PATRICIA
Last Name:BUSCH
Suffix:
Gender:F
Credentials:RN, LCCE, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 HAVENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7413
Mailing Address - Country:US
Mailing Address - Phone:614-891-0844
Mailing Address - Fax:
Practice Address - Street 1:481 HAVENDALE DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7413
Practice Address - Country:US
Practice Address - Phone:614-891-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CERTIFICATION# 10691174H00000X
CERTIFICATION # 4549374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator