Provider Demographics
NPI:1306382171
Name:BUSH, LISA M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:BUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:215-349-5680
Practice Address - Street 1:37 S 40TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3042
Practice Address - Country:US
Practice Address - Phone:215-444-7470
Practice Address - Fax:215-764-6556
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily