Individual
KATRINA ANN BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 E OMAHA ST APT B3, BROKEN ARROW, OK 74012-0363
(918) 896-9092
Mailing address
PO BOX 140114, BROKEN ARROW, OK 74014-0015
(918) 896-9092
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
68404
OK
Other
Enumeration date
12/22/2018
Last updated
12/22/2018
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