Most Relevant Information
Provider Data
| NPI Number: | 1003388497 |
| Provider Name: | KATRINA ANN BUSH |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 68404 |
Most Important Dates
| Enumeration Date: | 12/22/2018 |
| Last Updated: | 12/22/2018 |
Provider Practice Location
1721 E OMAHA ST APT B3
BROKEN ARROW
OK
740120363
Practice Location Phone/Fax
| Phone: | 9188969092 |
| Fax: |
Provider Mailing Location
PO BOX 140114
BROKEN ARROW
OK
740140015
Provider Mailing Phone/Fax
| Phone: | 9188969092 |
| Fax: |