Basic Information
Provider Information | |||||||||
NPI: | 1093950941 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUSH | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | JO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TURNER | ||||||||
OtherFirstName: | AMANDA | ||||||||
OtherMiddleName: | JO | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 78866 SWEDISHAMERICAN MEDICAL GROUP | ||||||||
Address2: |   | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532788866 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7796967150 | ||||||||
FaxNumber: | 7796967342 | ||||||||
Practice Location | |||||||||
Address1: | 1700 HENRY LUCKOW LN | ||||||||
Address2: |   | ||||||||
City: | BELVIDERE | ||||||||
State: | IL | ||||||||
PostalCode: | 61008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7796968650 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/06/2008 | ||||||||
LastUpdateDate: | 04/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | N3526 | TX | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VG0400X | MB0755263A | MA | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VG0400X | 036.125964 | IL | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.