Provider Demographics
NPI:1063762987
Name:BUSHUR, SARA MARIE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:BUSHUR
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 CALICO GDN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6661
Mailing Address - Country:US
Mailing Address - Phone:702-540-8263
Mailing Address - Fax:
Practice Address - Street 1:7711 LOUIS PASTEUR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3415
Practice Address - Country:US
Practice Address - Phone:210-593-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827588363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health