Provider Demographics
NPI:1366091266
Name:BUSCH, MELANIE KAY (CNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KAY
Last Name:BUSCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:MN
Mailing Address - Zip Code:56026-2057
Mailing Address - Country:US
Mailing Address - Phone:507-475-3310
Mailing Address - Fax:
Practice Address - Street 1:2200 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5503
Practice Address - Country:US
Practice Address - Phone:507-451-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily