Provider Demographics
NPI:1588780068
Name:BUSKIRK, MARLENE GRACE (RN)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:GRACE
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 1ST AVE NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2447
Mailing Address - Country:US
Mailing Address - Phone:612-436-0295
Mailing Address - Fax:
Practice Address - Street 1:615 1ST AVE NE
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2447
Practice Address - Country:US
Practice Address - Phone:612-436-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 043034-0364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-56672OtherUNITED BEHAVIORAL HEALTH