Provider Demographics
NPI:1689847535
Name:RICHARDSON BUSH, BERNADETTE MICHELE (LPN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MICHELE
Last Name:RICHARDSON BUSH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:MICHELE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1106 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-3719
Mailing Address - Country:US
Mailing Address - Phone:570-706-6381
Mailing Address - Fax:
Practice Address - Street 1:1106 SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18705-3719
Practice Address - Country:US
Practice Address - Phone:570-706-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN275529164W00000X
ARL33749164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse