Provider Demographics
NPI:1003467465
Name:BUSH, RUTHIE L (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:RUTHIE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:RUTHIE
Other - Middle Name:L
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIRLOSS S
Mailing Address - Street 1:8 BOSBY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1756
Mailing Address - Country:US
Mailing Address - Phone:251-604-3698
Mailing Address - Fax:
Practice Address - Street 1:8 BOSBY LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1756
Practice Address - Country:US
Practice Address - Phone:251-604-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL919421744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management