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Individual

JULIE ALLINA GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 848-0368
(253) 435-4937
Mailing address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 848-0368
(253) 435-4937

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD00017560
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7078017
WA
Enumeration date
01/30/2007
Last updated
05/21/2008
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