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General NPI Number Information
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NPI Number | 1336837020
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Entity Type | Individual
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Provider Name | BRIANNA MARIE BUSH PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 322 US HIGHWAY 41 STE 102
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City | SCHERERVILLE
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State | IN
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Zip | 46375-4203
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Country | US
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Telephone | 219-322-3131
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Fax | 219-322-9494
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004441A
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License Number State | IN
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