Healthcare Provider Details

I. General information

NPI: 1720591902
Provider Name (Legal Business Name): MICHELE BUSTARD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MYERS DRIVE UNIT 104
MULLICA HILL NJ
08062
US

IV. Provider business mailing address

5 MYERS DRIVE UNIT 104
MULLICA HILL NJ
08062
US

V. Phone/Fax

Practice location:
  • Phone: 856-431-6300
  • Fax: 856-431-6310
Mailing address:
  • Phone: 856-431-6300
  • Fax: 856-431-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00770500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: