Individual
MR. ANDREW KIRBY GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3614 PROVIDENCE RD S STE 200, WAXHAW, NC 28173-6310
(704) 384-8640
(704) 384-8650
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12435
NC
Other
Enumeration date
07/22/2022
Last updated
12/28/2022
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