Provider Demographics
NPI:1164033387
Name:BUSH, BRITA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRITA
Middle Name:LYNN
Last Name:BUSH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRITA
Other - Middle Name:LYNN
Other - Last Name:SUNDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:1200 PORT ARTHUR RD
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1137
Practice Address - Country:US
Practice Address - Phone:715-532-2300
Practice Address - Fax:715-532-2489
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily