Provider Demographics
NPI:1588971501
Name:BUSH, CHAR LYNN (ANP, GNP)
Entity type:Individual
Prefix:
First Name:CHAR
Middle Name:LYNN
Last Name:BUSH
Suffix:
Gender:F
Credentials:ANP, GNP
Other - Prefix:
Other - First Name:CHAR
Other - Middle Name:LYNN
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6470 PENTZ RD STE B
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3674
Mailing Address - Country:US
Mailing Address - Phone:530-872-6650
Mailing Address - Fax:
Practice Address - Street 1:6470 PENTZ RD STE B
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3674
Practice Address - Country:US
Practice Address - Phone:530-872-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20579363L00000X
MARN2259641363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health