MISS LISA K BUSHNELL C.F.N.P.

Allergy and Immunology

Taos, New Mexico

Provider NPI: 1174524912

Provider Information:
MISS LISA K BUSHNELL C.F.N.P.


Practice Location:
1353 PASEO DEL PUEBLO SUR STE D  TAOS, NM 87571 US
Tel: 575-613-8090  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	364SP0200X	Physician Assistants & Advanced Practice Nursing Providers Clinical Nurse Specialist Pediatrics	NM	R54485
Y	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner	NM	CNP01307
N	207K00000X	Physicians Allergy & Immunology	NM	R54485

Other Provider Identifiers:

Issuer	Number	State	Type
BLUE CROSS & BLUE SHIELD	NM006H13		01
CIGNA / LOVELACE	10021342		01
PRESBYTERIAN	202024643		01
	5670349	NM	05
AETNA	7722751		01
	00051474	NM	05
BLUE MEDICARE	00NM006H13	NM	01
MOLINA	QMP000003404562		01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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