Provider Demographics
NPI:1538631254
Name:BUSH, SAMANTHA Q (CRNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:Q
Last Name:BUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:142 HATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SMOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15480-1036
Mailing Address - Country:US
Mailing Address - Phone:724-208-3419
Mailing Address - Fax:
Practice Address - Street 1:111 ROBERTS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-2104
Practice Address - Country:US
Practice Address - Phone:724-785-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017636363LF0000X
PASP034063363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health