Basic Information
| Provider Information | |||||||||
| NPI: | 1750348470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSSE-QUENAN | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 GRIFFIN ST E | ||||||||
| Address2: | |||||||||
| City: | AMERY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152688000 | ||||||||
| FaxNumber: | 7152680311 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 GRIFFIN ST E | ||||||||
| Address2: | ARMC | ||||||||
| City: | AMERY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152688000 | ||||||||
| FaxNumber: | 7152680311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37864021 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G36301 | 01 | AMERICA'S PPO | OTHER | 390908320 | 01 | STANDARD TAX ID NUMB | OTHER | HP60877 | 01 | HEALTH PARTNERS | OTHER | 32289900 | 01 | GROUP HEALTH OF EAU | OTHER | P00341824 | 01 | PALMETTO GBA RR ME | OTHER | 312P88U | 01 | BLUE CROSS BLUE SHIE | OTHER | 32289900 | 05 | WI | MEDICAID | 0124794 | 01 | MEDICA PROVIDER NUMB | OTHER | 102691 | 01 | SECURITY HEALTH PLAN | OTHER | 1016661 | 01 | PREFERRED ONE | OTHER |