NPI 1114464765 · live from the CMS NPI Registry
Amanda M Bustle, CPNP
Nurse Practitioner, Pediatrics in Portage, MI. National Provider Identifier 1114464765, active.
NPI record
| NPI | 1114464765 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 2680 W Centre Ave, Portage, MI 49024 |
| Practice phone | 269-324-2400 |
| Mailing address | 5827 Corporate Way, West Palm Beach, FL 33407 |
| Enumerated | January 20, 2017 |
| Last updated | February 26, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics | 363LP0200X | 209.014881 (IL) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 4704419600 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.