Provider Demographics
NPI:1780167940
Name:BUSH, AMY BETH (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:BUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2332
Mailing Address - Country:US
Mailing Address - Phone:610-647-0330
Mailing Address - Fax:267-495-1707
Practice Address - Street 1:4610 E STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6612
Practice Address - Country:US
Practice Address - Phone:610-647-0330
Practice Address - Fax:267-495-1707
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-10-15
Deactivation Date:2018-10-03
Deactivation Code:
Reactivation Date:2018-10-10
Provider Licenses
StateLicense IDTaxonomies
PARN545080163WP0808X
PASP019362363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health