Individual
KRISTEN MARRON BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
PMG AT 8300 CONSTITUTION - GENERAL SURGERY, 8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110
(505) 291-5330
(505) 291-2949
Mailing address
5400 GIBSON BLVD SE, ALBUQUERQUE, NM 87108-4729
(505) 262-7960
(505) 232-1368
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA2004-0045
NM
Other
Enumeration date
05/09/2007
Last updated
06/26/2015
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