Provider Demographics
NPI:1174537542
Name:BUSCH, MICHELLE I (ANP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BUSCH
Suffix:I
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1621
Mailing Address - Country:US
Mailing Address - Phone:303-405-2100
Mailing Address - Fax:
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-561-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1294831363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0410386OtherMEDICA
MN410D6BUOtherBCBSMN
MNHP37268OtherHEALTHPARTNERS
MN114220800Medicaid
MN1174537542OtherAMERICA'S PPO
MN960931032384OtherPREFERRED ONE
MN142822C028OtherUCARE
MN114220800Medicaid
MN500003061Medicare PIN