Provider Demographics
NPI:1215115241
Name:BUSETTO, ELIZABETH (ND, DC, IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BUSETTO
Suffix:
Gender:F
Credentials:ND, DC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38706 PIONEER BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8008
Mailing Address - Country:US
Mailing Address - Phone:503-954-3676
Mailing Address - Fax:503-994-0294
Practice Address - Street 1:38706 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8008
Practice Address - Country:US
Practice Address - Phone:503-954-3676
Practice Address - Fax:503-994-0294
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5521111N00000X
L-89121174N00000X
OR1585175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675124Medicaid