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General NPI Number Information
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NPI Number | 1215461173
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Entity Type | Individual
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Provider Name | DANA BUSHMAN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 25500 MEADOWBROOK RD SUITE 260
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City | NOVI
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State | MI
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Zip | 48375-1878
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Country | US
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Telephone | 248-308-2604
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Fax |
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Provider Business Mailing Address
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Address Line | 2583 RAMBLING WAY
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-1039
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Country | US
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Telephone | 248-321-1306
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704290413
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704290413
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License Number State | MI
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