Individual
KELLY WILSON-GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LAT, ATC
Contact information
Practice address
1525 SNAFFLE BIT DR, GARDNERVILLE, NV 89410-5892
(775) 283-1710
Mailing address
1525 SNAFFLE BIT DR, GARDNERVILLE, NV 89410-5892
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/27/2017
Last updated
06/27/2017
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