Healthcare Provider Details

I. General information

NPI: 1396046918
Provider Name (Legal Business Name): NATALEE MARIE BUSSOLETTI WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 3RD AVE 2ND FLOOR
BRONX NY
10457-4501
US

IV. Provider business mailing address

4215 3RD AVE 2ND FLOOR
BRONX NY
10457-4501
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5891
  • Fax: 718-294-2468
Mailing address:
  • Phone: 718-294-5891
  • Fax: 718-294-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: