Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5007591 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4841 | CT |
NPI | 1023393667 |
---|---|
Provider Name | Amy A Bush |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28204-3215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2011 |
Last Update Date | 12/08/2021 |