Provider Demographics
NPI:1568091072
Name:AB GENUINE HEALTH, LLC
Entity Type:Organization
Organization Name:AB GENUINE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:ANASHA
Authorized Official - Middle Name:BUSH
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:409-351-1507
Mailing Address - Street 1:7635 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5648
Mailing Address - Country:US
Mailing Address - Phone:409-351-1507
Mailing Address - Fax:
Practice Address - Street 1:324 N 14TH ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4039
Practice Address - Country:US
Practice Address - Phone:409-351-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty