Individual
ALLISON LEIGH GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
83333-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100287020
—
WI
Enumeration date
03/23/2020
Last updated
12/20/2024
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