Provider Demographics
NPI:1649906868
Name:BUSYBEE IV
Entity type:Organization
Organization Name:BUSYBEE IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:503-828-8332
Mailing Address - Street 1:1345 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-9472
Mailing Address - Country:US
Mailing Address - Phone:503-828-8332
Mailing Address - Fax:
Practice Address - Street 1:1345 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-9472
Practice Address - Country:US
Practice Address - Phone:503-828-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598313876OtherOTHER