Provider Demographics
NPI:1285478768
Name:BUSS, CAROL
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:BUSS
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 1:540 N. FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-9562
Mailing Address - Country:US
Mailing Address - Phone:815-821-4476
Mailing Address - Fax:
Practice Address - Street 1:540 N. FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-9562
Practice Address - Country:US
Practice Address - Phone:815-821-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health