Provider Demographics
NPI:1366016818
Name:BUSSMAN, STEPHANIE (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BUSSMAN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 CRESTVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6159
Mailing Address - Country:US
Mailing Address - Phone:205-613-8154
Mailing Address - Fax:
Practice Address - Street 1:8375 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9573
Practice Address - Country:US
Practice Address - Phone:256-265-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126938367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered