Provider Demographics
NPI:1801040548
Name:FROST, BUSANDA LEE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:BUSANDA
Middle Name:LEE
Last Name:FROST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CHIIH'TOH BLVD INDUSTRIAL BLDG
Practice Address - Street 2:
Practice Address - City:SANDERS
Practice Address - State:AZ
Practice Address - Zip Code:86512-0125
Practice Address - Country:US
Practice Address - Phone:928-688-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2248032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily