Healthcare Provider Details

I. General information

NPI: 1548186521
Provider Name (Legal Business Name): MARACCA RENEE BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870 E KEMPER RD
CINCINNATI OH
45249-1675
US

IV. Provider business mailing address

1514 COLLEGEWOOD LN
CINCINNATI OH
45231-5356
US

V. Phone/Fax

Practice location:
  • Phone: 513-258-2053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042306
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.479734
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: