Individual
LISA BUSHHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7941 CASTLEWAY DR, INDIANAPOLIS, IN 46250-1953
(317) 771-6726
Mailing address
7941 CASTLEWAY DR, INDIANAPOLIS, IN 46250-1953
(317) 771-6726
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YM0800X
—
IN
Enumeration date
08/25/2022
Last updated
08/25/2022
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