Individual
TAMMY GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10356 RIDGE RD, DANBURY, WI 54830-9160
(715) 656-3316
Mailing address
10356 RIDGE RD, DANBURY, WI 54830-9160
(715) 656-3316
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34632-31
WI
Other
Enumeration date
04/20/2012
Last updated
04/20/2012
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