Provider Demographics
NPI:1942545223
Name:BUSHEY, JEANNETTA MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTA
Middle Name:MARY
Last Name:BUSHEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1751 PARK AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2831
Mailing Address - Country:US
Mailing Address - Phone:212-633-2500
Mailing Address - Fax:212-633-2932
Practice Address - Street 1:1751 PARK AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2831
Practice Address - Country:US
Practice Address - Phone:212-633-2500
Practice Address - Fax:212-633-2932
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY22 236324163WP0809X
NY730749141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical