Provider Demographics
NPI:1114795994
Name:BUSTAMANTE, REBEKAH ELISE (RN BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELISE
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:RN BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 N 70TH ST UNIT 209
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6339
Mailing Address - Country:US
Mailing Address - Phone:602-299-7475
Mailing Address - Fax:
Practice Address - Street 1:14040 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6117
Practice Address - Country:US
Practice Address - Phone:602-299-7475
Practice Address - Fax:623-806-8655
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL13683163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant