Provider Demographics
NPI:1295415917
Name:BUSH, PATRICIA G (BSN RN LTC NHA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:G
Last Name:BUSH
Suffix:
Gender:
Credentials:BSN RN LTC NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2805
Mailing Address - Country:US
Mailing Address - Phone:918-413-9788
Mailing Address - Fax:
Practice Address - Street 1:1504 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2805
Practice Address - Country:US
Practice Address - Phone:918-413-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0113507163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator