Most Relevant Information
Provider Data
| NPI Number: | 1003268640 |
| Provider Name: | MICAELA BUSACK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/07/2016 |
| Last Updated: | 07/07/2016 |
Provider Practice Location
3415 SE POWELL BLVD
PORTLAND
OR
972023371
Practice Location Phone/Fax
| Phone: | 5032349591 |
| Fax: |
Provider Mailing Location
3415 SE POWELL BLVD
PORTLAND
OR
972023371
Provider Mailing Phone/Fax
| Phone: | 5032349591 |
| Fax: |