Provider Demographics
NPI:1326349911
Name:BUSHNELL, SHERRY LEE (FNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 MEADOW CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805
Mailing Address - Country:US
Mailing Address - Phone:208-946-0640
Mailing Address - Fax:208-267-7854
Practice Address - Street 1:6448 CHINOOK ST.
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8380
Practice Address - Country:US
Practice Address - Phone:208-267-8710
Practice Address - Fax:208-549-7009
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily