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NPI Code Detail

MEDICARE: SUSAN E. BUSH CORDREY NP

MEDICARE: SUSAN E. BUSH CORDREY NP
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 PractitionerCOA.10961-NPOH

General Provider Information

NPI Number : 1811220635
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN E. BUSH CORDREY NP
Provider Business Mailing Address
First Line : 1425 COLUMBUS AVE
Second Line :
City : LEBANON
State : OH
Zip : 45036-8258
Country : US
Telephone Number : 513-282-3011
Fax Number : 513-282-3011
Provider Business Practice Location Address
First Line : 1425 COLUMBUS AVE
Second Line :
City : LEBANON
State : OH
Zip : 45036-8258
Country : US
Telephone Number : 513-282-3011
Fax Number : 513-282-3011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2009
Last Update Date : 06/28/2016

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