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MRS. AMANDA M BUSTLE APN

Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Pediatrics

Provider NPI: 1114464765

Provider Information:
MRS. AMANDA M BUSTLE APN
Gender: F
Not Sole Proprietor

Practice Location:
1200 W STATE ST  ROCKFORD, IL 61102-2112 US
Tel: 815-490-1600  Fax: 815-490-1881

Business Mailing Address:
1200 W STATE ST  ROCKFORD, IL 61102-2112 US
Tel: 815-490-1600  Fax: 815-490-1881

NPI Information:
NPI: 1114464765
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Pediatrics
IL209.014881

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 363LP0200X

Type:

Classification:



Definition:



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