Provider Demographics
NPI:1932592359
Name:BUSH, LAURIE (CPNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E 3RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5728
Mailing Address - Country:US
Mailing Address - Phone:970-375-0100
Mailing Address - Fax:
Practice Address - Street 1:810 E 3RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5728
Practice Address - Country:US
Practice Address - Phone:970-375-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991667363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care