Individual
MS. MALLORY LYNN GUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
440 ELM ST E, ANNANDALE, MN 55302-1109
(320) 274-3744
(320) 274-8194
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP 3741
MN
363LG0600X
Gerontology Nurse Practitioner
CNP 3741
MN
Other
Enumeration date
03/06/2015
Last updated
06/20/2024
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