Provider Demographics
NPI:1336383884
Name:BUSH, RENE A (NP)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:A
Last Name:BUSH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 COOLIDGE BLVD # 51573
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2435
Mailing Address - Country:US
Mailing Address - Phone:225-733-4790
Mailing Address - Fax:
Practice Address - Street 1:322B HEYMANN BLVD STE 8
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2449
Practice Address - Country:US
Practice Address - Phone:225-733-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 060763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner