Provider Demographics
NPI:1437165297
Name:BUSHNELL, DEBRA DARLENE (ANP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DARLENE
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E DAHILA AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6414
Mailing Address - Country:US
Mailing Address - Phone:907-745-1777
Mailing Address - Fax:907-745-0226
Practice Address - Street 1:425 E DAHILA AVE
Practice Address - Street 2:SUITE L
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6414
Practice Address - Country:US
Practice Address - Phone:907-745-1777
Practice Address - Fax:907-745-0226
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0811Medicaid
AKQ41566Medicare UPIN
AKNP0811Medicaid