Individual
JORDAN RICHARD GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1301 GRUNDMAN BLVD, NEBRASKA CITY, NE 68410-3319
(402) 873-3321
Mailing address
1301 GRUNDMAN BLVD, NEBRASKA CITY, NE 68410-3319
(402) 873-3321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2349
NE
Other
Enumeration date
03/14/2019
Last updated
03/14/2019
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