Provider Demographics
NPI:1811496342
Name:BUSTAMAMTE, MICHAELA L
Entity type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:L
Last Name:BUSTAMAMTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 4TH CT W
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-5315
Mailing Address - Country:US
Mailing Address - Phone:205-920-4816
Mailing Address - Fax:
Practice Address - Street 1:1331 4TH CT W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-5315
Practice Address - Country:US
Practice Address - Phone:205-920-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherHEALTHCARE