Individual
MRS. CHECHELLE MARIE TABLANG BUSTAMANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
18409 SHADY VIEW LN, BROOKEVILLE, MD 20833-2842
(301) 273-5195
Mailing address
18409 SHADY VIEW LN, BROOKEVILLE, MD 20833-2842
(301) 273-5195
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
R172810
MD
Other
Enumeration date
06/24/2007
Last updated
05/01/2024
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