Provider Demographics
NPI:1437542354
Name:BUSH, LEAH (CRNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
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 1:541 W COLLEGE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5323
Mailing Address - Country:US
Mailing Address - Phone:256-766-2118
Mailing Address - Fax:256-766-2101
Practice Address - Street 1:541 W COLLEGE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5323
Practice Address - Country:US
Practice Address - Phone:256-766-2118
Practice Address - Fax:256-766-2101
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner