Individual
CHAD GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NRP, IDHS
Contact information
Practice address
1650 17TH ST NW, WASHINGTON, DC 20500
(202) 814-6607
Mailing address
1650 17TH ST NW, WASHINGTON, DC 20500
(202) 814-6607
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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