Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036.125964 | IL |
N | 207VG0400X | Gynecologist | MB0755263A | MA |
N | 207VG0400X | Gynecologist | N3526 | TX |
NPI | 1093950941 |
---|---|
Provider Name | Dr. Amanda Jo Bush |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Belvidere, IL 61008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2008 |
Last Update Date | 15/04/2021 |