Provider Demographics
NPI:1477155489
Name:BUSH, SHARLOTTE SUE
Entity Type:Individual
Prefix:
First Name:SHARLOTTE
Middle Name:SUE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 HAVENS CORNERS RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7338
Mailing Address - Country:US
Mailing Address - Phone:740-927-5345
Mailing Address - Fax:
Practice Address - Street 1:14330 HAVENS CORNERS RD SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7338
Practice Address - Country:US
Practice Address - Phone:740-927-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker