MEDICARE: SAMANTHA Q BUSH CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP017636	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP034063	PA

General Provider Information

NPI Number	:	1538631254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA Q BUSH CRNP

Provider Business Mailing Address
First Line	:	142 HATFIELD RD
Second Line	:
City	:	SMOCK
State	:	PA
Zip	:	15480-1036
Country	:	US
Telephone Number	:	724-208-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 ROBERTS RD STE 150
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-2104
Country	:	US
Telephone Number	:	724-785-4346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	10/14/2025

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