Healthcare Provider Details

I. General information

NPI: 1861569568
Provider Name (Legal Business Name): ONA BUSH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SR 6W
TUNKHANNOCK PA
18657
US

IV. Provider business mailing address

452 DELLERT DRIVE
CLARKS SUMMIT PA
18411
US

V. Phone/Fax

Practice location:
  • Phone: 570-996-1238
  • Fax: 412-647-0342
Mailing address:
  • Phone: 570-586-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN553806
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: