Provider Demographics
NPI:1669007100
Name:BUSCH, SARA R (AGNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:BUSCH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROGRESS POINT PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-2207
Mailing Address - Country:US
Mailing Address - Phone:636-344-1073
Mailing Address - Fax:
Practice Address - Street 1:20 PROGRESS POINT PKWY STE 206
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2207
Practice Address - Country:US
Practice Address - Phone:636-344-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018042341363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health