Provider Demographics
NPI:1972765204
Name:BUSH, GAIL M (STNA)
Entity Type:Individual
Prefix:MISS
First Name:GAIL
Middle Name:M
Last Name:BUSH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 GREEN MEADOWS DR N APT A
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2758
Mailing Address - Country:US
Mailing Address - Phone:614-414-0787
Mailing Address - Fax:
Practice Address - Street 1:285 GREEN MEADOWS DR N APT A
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2758
Practice Address - Country:US
Practice Address - Phone:614-414-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist