Provider Demographics
NPI:1295506095
Name:BAGNE, ROBERT BUSTAMANTE (LPN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BUSTAMANTE
Last Name:BAGNE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9164 NOVEL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3087
Mailing Address - Country:US
Mailing Address - Phone:949-438-9086
Mailing Address - Fax:
Practice Address - Street 1:4040 S EASTERN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0854
Practice Address - Country:US
Practice Address - Phone:949-438-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862361164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse