Provider Demographics
NPI:1700827664
Name:BUSHEY, BRENDA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANN
Last Name:BUSHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:LOVEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22 CORPORATE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7901
Mailing Address - Country:US
Mailing Address - Phone:949-722-7038
Mailing Address - Fax:949-630-4930
Practice Address - Street 1:22 CORPORATE PLAZA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7901
Practice Address - Country:US
Practice Address - Phone:949-722-7038
Practice Address - Fax:949-630-4930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ41398Medicare UPIN