Individual
GENESIS I BUSTAMANTE VALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1610 MILLER PARK WAY STE 1600, WEST MILWAUKEE, WI 53214-3604
(414) 672-3801
(414) 672-6026
Mailing address
1610 MILLER PARK WAY STE 1600, WEST MILWAUKEE, WI 53214-3604
(414) 672-3801
(414) 672-6026
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
332918-31
WI
Other
Enumeration date
10/10/2025
Last updated
10/10/2025
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