Basic Information
Provider Information
NPI: 1053795757
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUSH
FirstName: EMILY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MSN, APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25 MERCHANT ST STE 220
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452463740
CountryCode: US
TelephoneNumber: 5135331199
FaxNumber: 5136459827
Practice Location
Address1: 6520 ACRO CT
Address2:  
City: CENTERVILLE
State: OH
PostalCode: 454592679
CountryCode: US
TelephoneNumber: 9372916830
FaxNumber: 9372916893
Other Information
ProviderEnumerationDate: 07/13/2015
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCOA.17554-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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