Provider Demographics
NPI:1972279206
Name:HERRON-BUSH, LASHAMIQUE RENEE
Entity Type:Individual
Prefix:
First Name:LASHAMIQUE
Middle Name:RENEE
Last Name:HERRON-BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 BELLA LEGATO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4047
Mailing Address - Country:US
Mailing Address - Phone:725-206-8757
Mailing Address - Fax:
Practice Address - Street 1:1137 HASSELL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2328
Practice Address - Country:US
Practice Address - Phone:702-557-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant