=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447761754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIA CHANEL BUSH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2017
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 S MARYLAND PKWY STE A5 #236
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89183-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-637-3854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9850 S. MARYLAND PKWY STE A-5 #236
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89183-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-637-3854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 894172
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------