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General NPI Number Information
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NPI Number | 1275842304
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Entity Type | Individual
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Provider Name | PAULA S BUSH R.N.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 5957 RT. 20 W
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City | LAFAYETTE
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State | NY
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Zip | 13159
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Country | US
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Telephone | 315-677-5501
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Fax | 315-677-3154
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Provider Business Mailing Address
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Address Line | 1675 NORTH RD
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City | TULLY
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State | NY
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Zip | 13159-9451
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Country | US
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Telephone | 315-677-5501
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Fax | 315-677-3154
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 271752
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License Number State | NY
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