| NPI | 1083804470 |
|---|---|
| Former Name | ANGELA MARIE BUSH (MAIDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN061159) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC005298) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2019-05-08 |