Provider Demographics
NPI:1538215520
Name:BUSH, ELIZABETH (APRN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-5234 HOHOLA DR
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8110
Mailing Address - Country:US
Mailing Address - Phone:808-885-5988
Mailing Address - Fax:
Practice Address - Street 1:64-5234 HOHOLA DRIVE
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:97343
Practice Address - Country:US
Practice Address - Phone:808-885-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1175-03101YA0400X
OR201391626RN163W00000X
HIRN-44613163W00000X
HI11515163WA0400X
WARN60273872363LP0808X
HIAPRN-228363LP0808X, 364SP0808X
OR201392090NP-PP363LP0808X, 364SP0808X
WAAP60273893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI7123100OtherUHA
HI25633202Medicaid
OR500769730Medicaid
HI00A240729OtherHMSA
HI256332OtherALOHACARE
HI7123100OtherUHA