Healthcare Provider Details

I. General information

NPI: 1932910080
Provider Name (Legal Business Name): FAITH D BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 201
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

512 3RD ST
MARIETTA OH
45750-2103
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-4590
  • Fax: 740-568-4592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010524RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: