Provider Demographics
NPI:1740585660
Name:BUSH, RONDA PHILLIPS (NP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:PHILLIPS
Last Name:BUSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:FAYE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:145 N CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-661-3737
Mailing Address - Fax:205-661-3739
Practice Address - Street 1:145 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1330
Practice Address - Country:US
Practice Address - Phone:205-661-3737
Practice Address - Fax:205-661-3739
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-082226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily