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Individual
KATELYN C GUSTAFSON
Active
Individual
KATELYN C GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704373177
MI
363LP2300X
Primary Care Nurse Practitioner
5008868
NC
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
71013513A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912454455
—
MI
Enumeration date
09/01/2016
Last updated
01/25/2023
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