Individual
MRS. TRACEY JO GUSTAVESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
14901 CANTRELL RD, LITTLE ROCK, AR 72223-4255
(501) 367-1200
Mailing address
14901 CANTRELL RD, LITTLE ROCK, AR 72223-4255
(501) 367-1200
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R091797
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R091797
ARKANSAS STATE BOARD OF NURSING
AR
Enumeration date
12/13/2022
Last updated
12/13/2022
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