Provider Demographics
NPI:1477755072
Name:BUSHBY, FAITH BRAYTON (LMP)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:BRAYTON
Last Name:BUSHBY
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 1:475 1ST ST
Mailing Address - Street 2:PO BOX 527
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8800
Mailing Address - Country:US
Mailing Address - Phone:360-221-5305
Mailing Address - Fax:
Practice Address - Street 1:221 2ND ST
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-8800
Practice Address - Country:US
Practice Address - Phone:360-221-5141
Practice Address - Fax:360-221-6242
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist