MEDICARE: MARQUETTA K BUSH

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	251E00000X	Home Health	363110231289E	OH

General Provider Information

NPI Number	:	1538614995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUETTA K BUSH

Provider Business Mailing Address
First Line	:	2017 BAKEWELL ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43605-1203
Country	:	US
Telephone Number	:	567-225-8414
Fax Number	:	419-698-4909

Provider Business Practice Location Address
First Line	:	2017 BAKEWELL ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43605-1203
Country	:	US
Telephone Number	:	567-225-8414
Fax Number	:	419-698-4909

Authorized Official
Title or Position	:	NURSING ASSISTANCE
Name	:	MARQUETTA BUSH
Credential	:
Telephone Number	:	567-225-8414

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/16/2016

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