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Individual

LEIGH ANNE GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGACNP-BC

Contact information

Practice address
827 SPRING ST, MEDFORD, OR 97504-6104
(541) 732-7600
(541) 732-7601
Mailing address
2678 KERRISDALE RIDGE DR, MEDFORD, OR 97504-5719
(541) 601-8569

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
202201187NP-PP
OR

Other

Enumeration date
02/03/2022
Last updated
02/03/2022
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