Provider Demographics
NPI:1316131345
Name:BUSH, MONICA LEIGH (CRNP)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LEIGH
Last Name:BUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 HALIFAX PL SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-7337
Mailing Address - Country:US
Mailing Address - Phone:256-280-8209
Mailing Address - Fax:
Practice Address - Street 1:1304 13TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4316
Practice Address - Country:US
Practice Address - Phone:256-280-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-053800363LF0000X, 363LX0106X
KY3008002363LX0106X
AL1-53800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health