Provider Demographics
NPI:1760607212
Name:BUSH, NANCY JO (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:BUSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 BRIDLE LN
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1117
Mailing Address - Country:US
Mailing Address - Phone:310-633-8400
Mailing Address - Fax:310-633-8419
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2023
Practice Address - Country:US
Practice Address - Phone:310-633-8400
Practice Address - Fax:310-633-8419
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280234163WX0200X
CA11178363L00000X
CA573364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0200XNursing Service ProvidersRegistered NurseOncology
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA573OtherCERTIFIED NURSE SPECIALIS
CA11178OtherNURSE PRACTIONER
CA280234OtherRN LICENSE