Provider Demographics
NPI:1396046918
Name:BUSSOLETTI, NATALEE MARIE (WHNP)
Entity type:Individual
Prefix:
First Name:NATALEE
Middle Name:MARIE
Last Name:BUSSOLETTI
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 3RD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-4501
Mailing Address - Country:US
Mailing Address - Phone:718-294-5891
Mailing Address - Fax:718-294-2468
Practice Address - Street 1:4215 3RD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4501
Practice Address - Country:US
Practice Address - Phone:718-294-5891
Practice Address - Fax:718-294-2468
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421006363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY00695941Medicaid