Provider Demographics
NPI:1407055593
Name:BUSHNELL, TONI RENE (LMP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:RENE
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15033 HWY 99
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2363
Mailing Address - Country:US
Mailing Address - Phone:425-218-3295
Mailing Address - Fax:
Practice Address - Street 1:15033 HWY 99
Practice Address - Street 2:SUITE A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-2363
Practice Address - Country:US
Practice Address - Phone:425-218-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195906OtherDEPARTMENT OF LABOR AND I