Provider Demographics
NPI:1295037265
Name:BUSHMAN, ERIN (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:KORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3380 TREMONT RD STE 280
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2140
Mailing Address - Country:US
Mailing Address - Phone:330-760-9702
Mailing Address - Fax:
Practice Address - Street 1:3380 TREMONT RD STE 280
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2140
Practice Address - Country:US
Practice Address - Phone:330-760-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6405133V00000X
OHLD.6405133V00000X
MO2017025888133V00000X
GALD004158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered