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Individual

ANTHONY FREDERICK BUSHNELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
315 EAST ELM, STE 100, CALDWELL, ID 83605
(208) 459-7415
(208) 453-3307
Mailing address
3340 E GOLDTONE WAY, MERIDIAN, ID 83642-1026
(208) 459-7415
(208) 453-3307

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1135
ID

Other

Enumeration date
04/09/2014
Last updated
12/02/2015
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