Provider Demographics
NPI:1689429094
Name:BUSSEY, SUE
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:BUSSEY
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 1:17016 COUNTY ROAD 3
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822-9636
Mailing Address - Country:US
Mailing Address - Phone:740-828-3610
Mailing Address - Fax:
Practice Address - Street 1:17016 COUNTY ROAD 3
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9636
Practice Address - Country:US
Practice Address - Phone:740-828-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant