1487900940 NPI number — DENA ALEXANDRA BUSHMAN RN, NP, MPH

Table of content: DENA ALEXANDRA BUSHMAN RN, NP, MPH (NPI 1487900940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487900940 NPI number — DENA ALEXANDRA BUSHMAN RN, NP, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSHMAN
Provider First Name:
DENA
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NP, MPH
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:
1487900940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 EMBARCADERO CTR
Provider Second Line Business Mailing Address:
LOBBY LEVEL
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94111-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-578-3100
Provider Business Mailing Address Fax Number:
415-291-0489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 EMBARCADERO CTR
Provider Second Line Business Practice Location Address:
LOBBY LEVEL
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94111-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-578-3100
Provider Business Practice Location Address Fax Number:
415-291-0489
Provider Enumeration Date:
08/01/2012

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: 363LA2200X , with the licence number:  22085 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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