Individual
BRANDIE N BUSTILLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
19305 RUBY DR, LEESBURG, VA 20176-6508
(571) 333-5918
Mailing address
PO BOX 772, WOONSOCKET, RI 02895-0784
(401) 770-4473
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024167338
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548488927
—
VA
Enumeration date
04/23/2007
Last updated
02/23/2012
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