Basic Information
| Provider Information | |||||||||
| NPI: | 1619187184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSWELL-CLEARY | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUSWELL | ||||||||
| OtherFirstName: | LINDSEY | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 420 W NORTH ST | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530391165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203868101 | ||||||||
| FaxNumber: | 9203868109 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 W NORTH ST | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530391165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203868101 | ||||||||
| FaxNumber: | 9203868109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.117396 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53878-21 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.