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1336837020 NPI number — BRIANNA MARIE BUSH PA-C

NPI Number: 1336837020
Health Care Provider/Practitioner: BRIANNA MARIE BUSH PA-C

Information about “1336837020” NPI (BRIANNA MARIE BUSH PA-C) exists in 1336837020 in HTML format HTML  |  1336837020 in plain Text format TXT  |  1336837020 in PDF (Portable Document Format) PDF  |  1336837020 in an XML format XML  formats.

NPI Number : 1336837020 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336837020",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUSH",
    "FirstName": "BRIANNA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8558 BROADWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERRILLVILLE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46410-7032",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-392-7084",
    "MailingAddressFaxNumber": "219-703-6854",
    "FirstLinePracticeLocationAddress": "322 US HIGHWAY 41 STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCHERERVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46375-4203",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-322-3131",
    "PracticeLocationAddressFaxNumber": "219-322-9494",
    "EnumerationDate": "05/01/2023",
    "LastUpdateDate": "08/19/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "10004441A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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