Provider Demographics
NPI:1285301424
Name:BUSSE, KAYLA LYNN
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:BUSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0133
Mailing Address - Country:US
Mailing Address - Phone:701-520-8735
Mailing Address - Fax:
Practice Address - Street 1:13911 95TH ST NE
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-9620
Practice Address - Country:US
Practice Address - Phone:701-265-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant