Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | R1465136 | MN |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R-146513-6 | MN |
NPI | 1336229251 |
---|---|
Provider Name | Mr. Dale Ray Buisman |
First Address | North Branch, MN 55056-3321 |
Second Address | Burnsville, MN 55337-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 22/07/2010 |