Individual
SAMANTHA MADISON GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
714 W PINE ST BLDG C, NEWPORT, WA 99156-9046
(509) 447-3139
(509) 897-8597
Mailing address
714 W PINE ST, NEWPORT, WA 99156-9046
(509) 447-3139
(509) 897-8597
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA61488948
WA
Other
Enumeration date
08/24/2022
Last updated
06/10/2024
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