Individual
LYNN K GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1421 PREMIERE DR, MANKATO CLINIC @ WICKERSHAM CAMPUS, MANKATO, MN 56001
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E MAIN ST, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
492
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115542
UCARE (MN)
—
01
—
1753435
AMERICA'S PPO (MN)
—
01
—
1M845GU
BCBS (MN)
—
01
—
2700674
MEDICA (MN)
—
01
—
480018263
RR MEDICARE
—
05
—
704325200
—
MN
01
—
937961
MEDICAID (IOWA)
—
01
—
HP26296
HEALTH PARTNERS (MN)
—
01
—
NA2951011002
PREFERRED ONE (MN)
—
Enumeration date
01/09/2006
Last updated
07/10/2020
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