1164607099 NPI number — MS. GRETCHEN ELIZABETH BUSHNELL MHA111

Table of content: MS. GRETCHEN ELIZABETH BUSHNELL MHA111 (NPI 1164607099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164607099 NPI number — MS. GRETCHEN ELIZABETH BUSHNELL MHA111

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSHNELL
Provider First Name:
GRETCHEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MHA111
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164607099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 FRANKLIN BLVD
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-1820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-394-9194
Provider Business Mailing Address Fax Number:
916-392-2827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-394-9194
Provider Business Practice Location Address Fax Number:
916-392-2827
Provider Enumeration Date:
01/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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