MEDICARE: MARIELA PETROVA BUSHEVA NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	262137	NC

General Provider Information

NPI Number	:	1407353253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELA PETROVA BUSHEVA NP-C

Provider Business Mailing Address
First Line	:	16415 NORTHCROSS DR STE B
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5001
Country	:	US
Telephone Number	:	704-775-6029
Fax Number	:	704-413-3198

Provider Business Practice Location Address
First Line	:	16415 NORTHCROSS DR STE B
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5001
Country	:	US
Telephone Number	:	704-775-6029
Fax Number	:	704-413-3198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	01/24/2022

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