Provider Demographics
NPI:1306312848
Name:BUSCH, JAMIE (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BUSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-5025
Mailing Address - Country:US
Mailing Address - Phone:605-553-3744
Mailing Address - Fax:
Practice Address - Street 1:1301 S CLIFF AVE STE 506
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1023
Practice Address - Country:US
Practice Address - Phone:605-335-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001479363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner