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Individual

MS. KAREN T. GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
2202 HARLEM RD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Mailing address
2202 HARLEM RD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041172766
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
2098004393
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
430075652
RAILROAD MEDICARE
Enumeration date
08/19/2006
Last updated
05/10/2017
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