Healthcare Provider Details

I. General information

NPI: 1144943044
Provider Name (Legal Business Name): LATIANNA CAIN-BUSH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N SWARTHMORE AVE
RIDLEY PARK PA
19078-3220
US

IV. Provider business mailing address

512 N SWARTHMORE AVE
RIDLEY PARK PA
19078-3220
US

V. Phone/Fax

Practice location:
  • Phone: 267-528-8414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP20221
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: