Provider Demographics
NPI:1497421986
Name:BUSHONG, CALLIE MARIA
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:MARIA
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-3437
Mailing Address - Fax:
Practice Address - Street 1:1215 LAWN AVE STE 120
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-523-2733
Practice Address - Fax:574-523-3251
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011411A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care