Basic Information
| Provider Information | |||||||||
| NPI: | 1184832016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSTAMANTE-CONWAY | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MED | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUSTAMANTE | ||||||||
| OtherFirstName: | ADRIANA | ||||||||
| OtherMiddleName: | MARIA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LIMHP, LMHP, LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4920 S 30TH ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681071656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027344110 | ||||||||
| FaxNumber: | 4029915642 | ||||||||
| Practice Location | |||||||||
| Address1: | 4920 S 30TH ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681071656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027344110 | ||||||||
| FaxNumber: | 4029915642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 915 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 1828 | NE | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 3666 | NE | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.