MEDICARE: SARAH ABBITT BUSH MS, RD

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	133V00000X	Registered Dietitian	L005261	NC

General Provider Information

NPI Number	:	1104398627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ABBITT BUSH MS, RD

Provider Business Mailing Address
First Line	:	258 DAREL ST
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-1333
Country	:	US
Telephone Number	:	252-333-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 DAREL ST
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-1333
Country	:	US
Telephone Number	:	252-333-7052
Fax Number	:

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

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	03/09/2023

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