Provider Demographics
NPI:1609355221
Name:BUSHEY, MARY JOY
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOY
Last Name:BUSHEY
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 1:3955 ALGONQUIN DR APT 19
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5371
Mailing Address - Country:US
Mailing Address - Phone:702-281-7340
Mailing Address - Fax:
Practice Address - Street 1:9371 MALAYA GARNET CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3880
Practice Address - Country:US
Practice Address - Phone:702-445-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant