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General NPI Number Information
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NPI Number | 1093741316
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Entity Type | Individual
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Provider Name | ANDREA BERNADETTE BUSHAW APN/CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 2525 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404
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Country | US
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Telephone | 529-992-5316
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 SHERMAN CIR
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City | EDINA
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State | MN
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Zip | 55436-1953
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Country | US
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Telephone | 763-355-2484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R1924994
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License Number State | MN
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