Individual
MALYNDA LYNN TUSHBANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
580 W 5TH ST, RENO, NV 89503-4407
(775) 786-4673
(775) 348-2889
Mailing address
580 W 5TH ST, RENO, NV 89503-4407
(775) 786-4673
(775) 348-2889
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0200
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CZ375Z
MEDICARE PTAN
—
01
—
PA0200
LICENSE
NV
01
—
PA1737
LICENSE
NV
Enumeration date
01/11/2010
Last updated
03/07/2023
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