Provider Demographics
NPI:1760897524
Name:BUSTOS, BERTHA I (RN, CDE)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:I
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 COWICHE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9466
Mailing Address - Country:US
Mailing Address - Phone:509-965-7727
Mailing Address - Fax:
Practice Address - Street 1:5900 COWICHE CANYON RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9466
Practice Address - Country:US
Practice Address - Phone:509-965-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00122198163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator