Healthcare Provider Details

I. General information

NPI: 1447761754
Provider Name (Legal Business Name): INDIA CHANEL BUSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INDIA CHANEL MCCLOUD RN

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date: 04/10/2018
Reactivation Date: 12/10/2025

III. Provider practice location address

9850 S MARYLAND PKWY STE A5 #236
LAS VEGAS NV
89183-7148
US

IV. Provider business mailing address

9850 S. MARYLAND PKWY STE A-5 #236
LAS VEGAS NV
89183-7148
US

V. Phone/Fax

Practice location:
  • Phone: 702-637-3854
  • Fax:
Mailing address:
  • Phone: 702-637-3854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number894172
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: