Provider Demographics
NPI:1538306253
Name:BUSH, SHERRY LEA (CMT/CNA/CPR/INSULIN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEA
Last Name:BUSH
Suffix:
Gender:F
Credentials:CMT/CNA/CPR/INSULIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1962
Mailing Address - Country:US
Mailing Address - Phone:636-933-9929
Mailing Address - Fax:
Practice Address - Street 1:222 N 3RD ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1962
Practice Address - Country:US
Practice Address - Phone:636-933-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005588374700000X, 3747A0650X, 3747P1801X
MO102032376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide