Nicole Bustillos

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Practice address

2727 Cedar St
Fennville, MI 49408-9661

Phone

(616) 655-6834

NPI assigned

Jul 2, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656720000000",
    "number": "1639802192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 762",
            "city": "FENNVILLE",
            "state": "MI",
            "postal_code": "494080762",
            "telephone_number": "269-286-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 CEDAR ST",
            "city": "FENNVILLE",
            "state": "MI",
            "postal_code": "494089661",
            "telephone_number": "616-655-6834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTILLOS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-02",
        "last_updated": "2022-07-02",
        "certification_date": "2022-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ascension Borgess Allegan Hospital
• Phillip Louis Badra, M.D.
• Kanani Baker, LCSW
• Gloria Jean Braswell
• Courtney Renee Broderick
• Thomas Harold Cassell, DDS
• Richard Glenn Coleman, M.D.
• Darshan M Collins
• Katelin Elizabeth Dekker, NP
• Beth Durkee, LMSW

• All providers in Fennville, MI
• In Home Supportive Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.