Provider Demographics
NPI:1013313204
Name:BUSH, CADORA (RNC)
Entity Type:Individual
Prefix:
First Name:CADORA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22750 WOODWARD AVE
Mailing Address - Street 2:STE. #309
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1777
Mailing Address - Country:US
Mailing Address - Phone:248-545-8787
Mailing Address - Fax:
Practice Address - Street 1:22750 WOODWARD AVE
Practice Address - Street 2:STE. #309
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1777
Practice Address - Country:US
Practice Address - Phone:248-545-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131505163WA2000X, 163WC0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health