Provider Demographics
NPI:1376979054
Name:BUSH, NAKIYA SHARICE
Entity Type:Individual
Prefix:MRS
First Name:NAKIYA
Middle Name:SHARICE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NAKIYA
Other - Middle Name:SHARICE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3552 WESSON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5674
Mailing Address - Country:US
Mailing Address - Phone:614-783-9842
Mailing Address - Fax:
Practice Address - Street 1:3552 WESSON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5674
Practice Address - Country:US
Practice Address - Phone:614-783-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153932164W00000X
OHRN484462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse