Provider Demographics
NPI:1699289330
Name:BUSH, JAMIE L (CRNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:174 BUCKAROO LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9119
Practice Address - Country:US
Practice Address - Phone:814-353-1030
Practice Address - Fax:814-353-1053
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP018120207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine