Provider Demographics
NPI:1285763847
Name:BUSHEY, DERE RANDOLPH (BSN)
Entity type:Individual
Prefix:MR
First Name:DERE
Middle Name:RANDOLPH
Last Name:BUSHEY
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 N STUDEBAKER RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4838
Mailing Address - Country:US
Mailing Address - Phone:562-598-0553
Mailing Address - Fax:
Practice Address - Street 1:1437 N STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4838
Practice Address - Country:US
Practice Address - Phone:562-598-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN288389163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health