MEDICARE: ANNIE BUSH

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	164X00000X	Licensed Vocational Nurse	LPN112029	OH

General Provider Information

NPI Number	:	1659960318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE BUSH

Provider Business Mailing Address
First Line	:	3069 SUGAR RIDGE RD
Second Line	:
City	:	PEMBERVILLE
State	:	OH
Zip	:	43450-9637
Country	:	US
Telephone Number	:	416-344-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3069 SUGAR RIDGE RD
Second Line	:
City	:	PEMBERVILLE
State	:	OH
Zip	:	43450-9637
Country	:	US
Telephone Number	:	416-344-0008
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “ ANNIE BUSH ” Practice Location

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