Provider Demographics
NPI:1770968091
Name:BUSCH, SARA (CNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BUSCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:1955 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1058
Practice Address - Country:US
Practice Address - Phone:740-689-2820
Practice Address - Fax:740-689-2830
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17689-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139922Medicaid
OHH436080Medicare PIN
OHH436081Medicare PIN