Provider Demographics
NPI:1902161755
Name:BUSCH, MARIETTA C (RN)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:C
Last Name:BUSCH
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:P.O. BOX 924
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073
Mailing Address - Country:US
Mailing Address - Phone:507-359-2756
Mailing Address - Fax:507-354-1260
Practice Address - Street 1:6 NORTH MINNESOTA STREET
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073
Practice Address - Country:US
Practice Address - Phone:507-359-2756
Practice Address - Fax:507-354-1260
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127644-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse