Provider Demographics
NPI:1326299884
Name:BUSH, LANETT SHARLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:LANETT
Middle Name:SHARLENE
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 1:3648 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2806
Mailing Address - Country:US
Mailing Address - Phone:510-222-3034
Mailing Address - Fax:
Practice Address - Street 1:3648 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-2806
Practice Address - Country:US
Practice Address - Phone:510-222-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse