Healthcare Provider Details

I. General information

NPI: 1023278181
Provider Name (Legal Business Name): REBECCA A BUSH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE SECTION OF ANESTHESIOLOGY
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE SECTION OF ANESTHESIOLOGY
COLUMBUS OH
43205-2654
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4200
  • Fax: 614-722-4203
Mailing address:
  • Phone: 614-722-4200
  • Fax: 614-722-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN189470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: