Individual
MS. DEBRA ANN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
27 N 31ST ST, NEWARK, OH 43055-2007
(740) 322-3591
Mailing address
27 N 31ST ST, NEWARK, OH 43055-2007
(740) 322-3591
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.082012
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2480275
—
OH
Enumeration date
03/02/2007
Last updated
06/04/2024
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