Provider Demographics
NPI:1356679294
Name:BUSH-JETER, MARYANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:BUSH-JETER
Suffix:
Gender:F
Credentials:LPN
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 1163
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-6163
Mailing Address - Country:US
Mailing Address - Phone:740-284-1170
Mailing Address - Fax:
Practice Address - Street 1:1419 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2505
Practice Address - Country:US
Practice Address - Phone:740-284-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN150490L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse