Provider Demographics
NPI:1508904343
Name:BUSH, DANYELLE DENISE
Entity Type:Individual
Prefix:MRS
First Name:DANYELLE
Middle Name:DENISE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 PAULSON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5145
Mailing Address - Country:US
Mailing Address - Phone:910-978-8045
Mailing Address - Fax:
Practice Address - Street 1:5012 PAULSON DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5145
Practice Address - Country:US
Practice Address - Phone:910-978-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3121251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health