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General NPI Number Information
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NPI Number | 1376484592
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Entity Type | Individual
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Provider Name | ANDRE LAZARO BUSTAMANTE APRN
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Gender | Male
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 2 SAINT VINCENT CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5499
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Country | US
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Telephone | 501-552-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 525 FELDSPAR DR
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City | SHERWOOD
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State | AR
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Zip | 72120-2379
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Country | US
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Telephone | 501-400-5577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 214782
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License Number State | AR
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