Provider Demographics
NPI:1134456379
Name:BUSH, CARLA DENISE (RNP, CNM)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:DENISE
Last Name:BUSH
Suffix:
Gender:F
Credentials:RNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3707
Mailing Address - Country:US
Mailing Address - Phone:909-881-1683
Mailing Address - Fax:909-881-4215
Practice Address - Street 1:249 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3707
Practice Address - Country:US
Practice Address - Phone:909-881-1683
Practice Address - Fax:909-881-1683
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9771363LW0102X
CA1349367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health