MEDICARE: SHUNTIA 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	1744P3200X	Prosthetics Case Management		AR

General Provider Information

NPI Number	:	1942697123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNTIA BUSH

Provider Business Mailing Address
First Line	:	213 LINDENHURST DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72118-3104
Country	:	US
Telephone Number	:	501-626-8507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 W 37TH ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72118-4832
Country	:	US
Telephone Number	:	501-812-4832
Fax Number	:

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

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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Directions to “ SHUNTIA BUSH ” Practice Location

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