Provider Demographics
NPI:1952610743
Name:BUSHMAN, BRIAN ANDREW (APRN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANDREW
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5044
Mailing Address - Country:US
Mailing Address - Phone:801-374-9100
Mailing Address - Fax:801-374-9117
Practice Address - Street 1:1055 N 300 W STE 205
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5044
Practice Address - Country:US
Practice Address - Phone:801-374-9100
Practice Address - Fax:801-374-9117
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5127528-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily