Provider Demographics
NPI:1275842304
Name:BUSH, PAULA S (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:S
Last Name:BUSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-9451
Mailing Address - Country:US
Mailing Address - Phone:315-677-5501
Mailing Address - Fax:315-677-3154
Practice Address - Street 1:5957 RT. 20 W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13159
Practice Address - Country:US
Practice Address - Phone:315-677-5501
Practice Address - Fax:315-677-3154
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271752163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse