Provider Demographics
NPI:1558492678
Name:BUSH, CATHERINE L (ANP-LPA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:ANP-LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HOLLY HALL ST
Mailing Address - Street 2:ROOM 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4124
Mailing Address - Country:US
Mailing Address - Phone:713-566-6711
Mailing Address - Fax:713-440-1200
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-566-6711
Practice Address - Fax:713-440-1200
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ41463Medicare UPIN
TX8E0436Medicare ID - Type UnspecifiedMEDICARE NUMBER