Provider Demographics
NPI:1184832016
Name:BUSTAMANTE-CONWAY, ADRIANA MARIA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:MARIA
Last Name:BUSTAMANTE-CONWAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:ADRIANA
Other - Middle Name:MARIA
Other - Last Name:BUSTAMANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP, LMHP, LPC
Mailing Address - Street 1:4920 S 30TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1656
Mailing Address - Country:US
Mailing Address - Phone:402-734-4110
Mailing Address - Fax:402-991-5642
Practice Address - Street 1:4920 S 30TH ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1656
Practice Address - Country:US
Practice Address - Phone:402-734-4110
Practice Address - Fax:402-991-5642
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE915101YM0800X
NE1828101YP2500X
NE3666101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor