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General NPI Number Information
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NPI Number | 1235522855
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Entity Type | Individual
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Provider Name | LAUREN MARIE BUSHMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 855 N WESTHAVEN DR STE 220
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City | OSHKOSH
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State | WI
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Zip | 54904-7668
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Country | US
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Telephone | 920-303-8800
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Fax | 920-303-8993
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Provider Business Mailing Address
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Address Line | 949 WINDSOR ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6146
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Country | US
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Telephone | 920-573-3463
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6484
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License Number State | WI
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