Provider Demographics
NPI:1295503753
Name:BISH, LURENA ANN
Entity type:Individual
Prefix:MS
First Name:LURENA
Middle Name:ANN
Last Name:BISH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENA
Other - Middle Name:ANN
Other - Last Name:BISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:606 W 10 RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-4100
Mailing Address - Country:US
Mailing Address - Phone:402-631-7375
Mailing Address - Fax:
Practice Address - Street 1:4483 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-454-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE88131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse