Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 26935 | WV |
NPI | 1033371711 |
---|---|
Provider Name | Carrie Marie Bush |
First Address | Charleston, WV 25302-3302 |
Second Address | Charleston, WV 25302-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 03/11/2016 |