Healthcare Provider Details

I. General information

NPI: 1174937288
Provider Name (Legal Business Name): HANNAH ROSE BUSHNELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH ROSE BILLINGS

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 SAINT JOSEPHS BLVD STE 304
ELMIRA NY
14901-3234
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-7012
  • Fax: 607-735-5594
Mailing address:
  • Phone: 607-271-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number281714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: