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Individual

SUSAN STEPHANIE GUSTAFSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
7951 250TH ST, FOREST LAKE, MN 55025-8370
(651) 231-2048
Mailing address
7951 250TH ST, FOREST LAKE, MN 55025-8370
(651) 231-2048

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L71970-2
MN

Other

Enumeration date
05/09/2015
Last updated
05/09/2015
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