Provider Demographics
NPI:1477143543
Name:BUSTAMANTE, NATASHA ASHLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ASHLEY
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:ASHLEY
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:700 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4666
Mailing Address - Country:US
Mailing Address - Phone:575-838-2647
Mailing Address - Fax:
Practice Address - Street 1:1425 EL CAMINO REAL ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4810
Practice Address - Country:US
Practice Address - Phone:575-838-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-82076163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool