Provider Demographics
NPI:1649309956
Name:BUSBY, SANDRA SUE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:BUSBY
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 1:3900 STATE ROUTE 98
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9354
Mailing Address - Country:US
Mailing Address - Phone:419-562-5149
Mailing Address - Fax:
Practice Address - Street 1:3900 STATE ROUTE 98
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-9354
Practice Address - Country:US
Practice Address - Phone:419-562-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405070OtherSTATE PROVIDER NUMBER