NPI 1083775613

Brent a Bushnell, IDC

Practitioner Independent Duty Corpsman Fpo, AE

Practice location

Address: Psc 814 Box 19, Fpo, AE 09865
Phone: 0113028221021590
Fax: 011302821021589

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1083775613
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Dec 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.