Individual
ANISSA A GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
3006 S MARYLAND PKWY, SUITE 690, LAS VEGAS, NV 89109-2218
(702) 732-1290
(702) 732-0992
Mailing address
3006 S MARYLAND PKWY, SUITE 690, LAS VEGAS, NV 89109-2218
(702) 732-1290
(702) 732-0992
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
844704
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
844704
ADA MEMBERSHIP NUMBER
NV
Enumeration date
04/11/2007
Last updated
07/08/2007
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