Provider Demographics
NPI:1174937288
Name:BUSHNELL, HANNAH ROSE (DO)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ROSE
Other - Last Name:BILLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:571 SAINT JOSEPHS BLVD STE 304
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3234
Practice Address - Country:US
Practice Address - Phone:607-737-7012
Practice Address - Fax:607-735-5594
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2817142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05323097Medicaid
PA103598681Medicaid