Healthcare Provider Details

I. General information

NPI: 1538306253
Provider Name (Legal Business Name): SHERRY LEA BUSH CMT/CNA/CPR/INSULIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 3RD ST
FESTUS MO
63028-1962
US

IV. Provider business mailing address

222 N 3RD ST
FESTUS MO
63028-1962
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-9929
  • Fax:
Mailing address:
  • Phone: 636-933-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number005588
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number005588
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number005588
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number102032
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: