Provider Demographics
NPI:1588360093
Name:BUSH, INDIA C
Entity type:Individual
Prefix:
First Name:INDIA
Middle Name:C
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SPENCER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2951
Mailing Address - Country:US
Mailing Address - Phone:513-571-2567
Mailing Address - Fax:
Practice Address - Street 1:2020 SPENCER LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2951
Practice Address - Country:US
Practice Address - Phone:513-571-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTN538944372600000X
OH376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide