Provider Demographics
NPI:1720612559
Name:BUSHNELL, PAIGE MARIE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:BUSHNELL
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:PO BOX 50295
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0295
Mailing Address - Country:US
Mailing Address - Phone:307-315-5091
Mailing Address - Fax:
Practice Address - Street 1:2241 FARNUM ST STE 102
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4108
Practice Address - Country:US
Practice Address - Phone:307-315-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator