Provider Demographics
NPI:1407064975
Name:BUSH, REBECCA ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:BUSH
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Gender:F
Credentials:ND
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Mailing Address - Street 1:105 NEW ENGLAND PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5783
Mailing Address - Country:US
Mailing Address - Phone:651-342-1043
Mailing Address - Fax:866-462-6742
Practice Address - Street 1:105 NEW ENGLAND PL
Practice Address - Street 2:SUITE 220
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5783
Practice Address - Country:US
Practice Address - Phone:651-342-1043
Practice Address - Fax:866-462-6742
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-05-16
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Provider Licenses
StateLicense IDTaxonomies
MN1011175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1011OtherMN STATE MEDICAL BOARD