Provider Information for 1730678525
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BRETT BRIAN CUSHING
Sex: Male
NPI: 1730678525
Last Updated: 2024-03-23
Certification Date: 2024-03-23
Certification Date: 2024-03-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1730678525 | ||||||||
| Enumeration Date | 2018-05-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11010 PRAIRIE LAKES DR EDEN PRAIRIE, MN 55344-3884 United States Phone: 952-746-2522 | Fax: | ||||||||
| Primary Practice Address | 11010 PRAIRIE LAKES DR EDEN PRAIRIE, MN 55344-3884 United States Phone: 952-746-2522 | Fax: | ||||||||
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