Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 827588 | TX |
NPI | 1063762987 |
---|---|
Provider Name | Sara Marie Bushur |
First Address | San Antonio, TX 78260-6661 |
Second Address | San Antonio, TX 78229-3415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 19/11/2012 |