Healthcare Provider Details

I. General information

NPI: 1922074152
Provider Name (Legal Business Name): CECELIA BUSH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECELIA BUSH RN

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GRANT AVE
COLUMBUS OH
43215-5537
US

IV. Provider business mailing address

360 S GRANT AVE
COLUMBUS OH
43215-5537
US

V. Phone/Fax

Practice location:
  • Phone: 614-398-3470
  • Fax: 614-340-3083
Mailing address:
  • Phone: 614-398-3470
  • Fax: 614-340-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: