Individual
MRS. MARY BETH BUSTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
6050 STERLING CREEK RD, PORTAGE, IN 46368-7752
(219) 763-8112
Mailing address
16401 PEPPERWOOD TRL, ORLAND HILLS, IL 60487-5648
(708) 522-2372
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.020437
IL
Other
Enumeration date
11/22/2019
Last updated
06/08/2021
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