Healthcare Provider Details

I. General information

NPI: 1548541550
Provider Name (Legal Business Name): LAURA CHRISTINA BUSH CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 CENTRAL AVE NE
ALBUQUERQUE NM
87108-2015
US

IV. Provider business mailing address

4804 HAINES AVE NE
ALBUQUERQUE NM
87110-5009
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax: 505-265-7045
Mailing address:
  • Phone: 858-442-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01842
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: