Provider Demographics
NPI:1336890631
Name:BUSSIE, JUANITA E (RN)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:E
Last Name:BUSSIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-2802
Mailing Address - Country:US
Mailing Address - Phone:215-288-3653
Mailing Address - Fax:215-288-3653
Practice Address - Street 1:2945 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2802
Practice Address - Country:US
Practice Address - Phone:215-288-3653
Practice Address - Fax:215-288-3653
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN273200L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN273200LOtherREGISTERED NURSE