Provider Demographics
NPI:1043860737
Name:BUSCH, DEANA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:MARIE
Last Name:BUSCH
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3786 S MONTECITO ST
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2926
Mailing Address - Country:US
Mailing Address - Phone:801-910-0853
Mailing Address - Fax:
Practice Address - Street 1:4646 S HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-5270
Practice Address - Country:US
Practice Address - Phone:801-871-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11453601-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily