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NPI Code Detail

MEDICARE: MICHELLE DENISE BUSH RN, MSN, CRNP-BC

MEDICARE: MICHELLE DENISE BUSH RN, MSN, CRNP-BC
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
1363LF0000XFamily Nurse PractitionerRN256477GA

General Provider Information

NPI Number : 1154450484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DENISE BUSH RN, MSN, CRNP-BC
Provider Business Mailing Address
First Line : 3758 HIGHWAY 42
Second Line :
City : LOCUST GROVE
State : GA
Zip : 30248-3653
Country : US
Telephone Number : 678-561-9430
Fax Number : 770-914-1070
Provider Business Practice Location Address
First Line : 3758 HIGHWAY 42
Second Line :
City : LOCUST GROVE
State : GA
Zip : 30248-3653
Country : US
Telephone Number : 678-561-9430
Fax Number : 770-914-1070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2007
Last Update Date : 01/25/2017

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