Individual
ETHAN BUSHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3600 BROADWAY, OAKLAND, CA 94611-5730
(510) 752-1000
Mailing address
3600 BROADWAY, OAKLAND, CA 94611-5730
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
686467
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000254
CA
Other
Enumeration date
12/22/2014
Last updated
01/03/2022
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