Provider Demographics
NPI:1841447786
Name:BUSH, LESLIE CHARLES (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CHARLES
Last Name:BUSH
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 HEATHER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2954
Mailing Address - Country:US
Mailing Address - Phone:661-496-3533
Mailing Address - Fax:661-587-0427
Practice Address - Street 1:10224 HEATHER VALLEY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2954
Practice Address - Country:US
Practice Address - Phone:661-496-3533
Practice Address - Fax:661-587-0427
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551612163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health