Individual
DR. CHERYL JANENE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3216 NE 45TH PL STE 101, SEATTLE, WA 98105-4028
(206) 525-1168
(206) 525-1169
Mailing address
PO BOX 24325, SEATTLE, WA 98124-0325
(062) 327-5462
(503) 362-8435
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01075298A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD60757392
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2084320
—
WA
Enumeration date
06/10/2009
Last updated
01/29/2021
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