Individual
MELISSA JEAN GUSTAFSON
Active
Individual
MELISSA JEAN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, OCN, FNP
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
2014024546
MO
363LF0000X
Family Nurse Practitioner
Primary
2019023268
MO
363LF0000X
Family Nurse Practitioner
53-80212-062
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201246680A
—
KS
05
—
420072547
—
MO
Enumeration date
06/03/2019
Last updated
05/29/2024
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