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General NPI Number Information
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NPI Number | 1356013403
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Entity Type | Individual
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Provider Name | CANDY LYNN BUSH FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 142 HIGHLAND DR
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City | LEBANON
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State | VA
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Zip | 24266-4636
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Country | US
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Telephone | 276-889-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 1683 BRICK CHURCH CIR
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City | CASTLEWOOD
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State | VA
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Zip | 24224-5879
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Country | US
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Telephone | 276-698-8738
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024182736
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License Number State | VA
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