Provider Demographics
NPI:1033304829
Name:BUSH, ROSALIE JO (CNS)
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:JO
Last Name:BUSH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1056 E 19TH AVE
Mailing Address - Street 2:BOX 395
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1007
Mailing Address - Country:US
Mailing Address - Phone:303-864-5622
Mailing Address - Fax:303-837-2924
Practice Address - Street 1:1056 E 19TH AVE
Practice Address - Street 2:BOX 395
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1007
Practice Address - Country:US
Practice Address - Phone:303-864-5622
Practice Address - Fax:303-837-2924
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46999364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics