MEDICARE: MS. SUSAN BUSH CNM

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	367A00000X	Advanced Practice Midwife	83360	CO

General Provider Information

NPI Number	:	1477541050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BUSH CNM

Provider Business Mailing Address
First Line	:	1107 S LEMAY AVE
Second Line	:	SUITE 300
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3960
Country	:	US
Telephone Number	:	970-493-7442
Fax Number	:	970-493-2990

Provider Business Practice Location Address
First Line	:	2500 ROCKY MOUNTAIN AVE
Second Line	:	NORTH MOB SUITE 150
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-493-7442
Fax Number	:	970-493-2990

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

Provider Enumeration Date	:	10/08/2005
Last Update Date	:	02/20/2012

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