Healthcare Provider Details

I. General information

NPI: 1851752497
Provider Name (Legal Business Name): DAWN KRISTIN BUSTAMANTE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PLACE NE SUITE A6
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

801 ENCINO PL NE STE A6
ALBUQUERQUE NM
87102-2641
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-3594
  • Fax:
Mailing address:
  • Phone: 505-224-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02876
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: