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Individual
VICKIE CONSUELLA71 BUSH
Active
Individual
VICKIE CONSUELLA71 BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
456669
GA
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
456669
ARRT
GA
Enumeration date
02/27/2019
Last updated
02/28/2019
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