Individual
AMBER JOY GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2845 US 2 & 41, SUITE 201, BARK RIVER, MI 49807
(906) 466-2000
(906) 466-2067
Mailing address
2845 US 2 & 41, SUITE 201, BARK RIVER, MI 49807
(906) 466-2000
(906) 466-2067
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005343
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG005343
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/25/2008
Last updated
03/06/2014
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