Provider Demographics
NPI:1235469446
Name:TUSHBANT, MALYNDA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MALYNDA
Middle Name:LYNN
Last Name:TUSHBANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MALYNDA
Other - Middle Name:LYNN
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4407
Mailing Address - Country:US
Mailing Address - Phone:775-786-4673
Mailing Address - Fax:775-348-2889
Practice Address - Street 1:580 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4407
Practice Address - Country:US
Practice Address - Phone:775-786-4673
Practice Address - Fax:775-348-2889
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA0200OtherLICENSE
CZ375ZOtherMEDICARE PTAN
NVPA1737OtherLICENSE