Provider Demographics
NPI:1992451769
Name:BUSH, COREY (FNTP)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3973
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3973
Mailing Address - Country:US
Mailing Address - Phone:805-455-5158
Mailing Address - Fax:
Practice Address - Street 1:136 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-9509
Practice Address - Country:US
Practice Address - Phone:805-455-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date: