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Individual

CHAD GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2695 PINE RIDGE BLVD, RED WING, MN 55066-3978
(612) 244-0894
Mailing address
2695 PINE RIDGE BLVD, RED WING, MN 55066-3978
(612) 244-0894

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R 147790-4
MN

Other

Enumeration date
12/18/2015
Last updated
12/18/2015
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