Provider Demographics
NPI:1275338782
Name:EATON BUSTILLOS, AMY LYNN (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:EATON BUSTILLOS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 OLD ANNAPOLIS RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2182
Mailing Address - Country:US
Mailing Address - Phone:410-531-6006
Mailing Address - Fax:
Practice Address - Street 1:8990 OLD ANNAPOLIS RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2182
Practice Address - Country:US
Practice Address - Phone:410-531-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118549163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health