Individual
JACQUELINE M GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2525 CHICAGO AVE S, CHILDRENS SPECIALTY CLINIC FEEDING CLINIC MPLS, MINNEAPOLIS, MN 55404
(651) 220-6446
(651) 220-6860
Mailing address
2910 CENTRE POINTE DR, 35-121A CHILDRENS HEALTH CARE, ROSEVILLE, MN 55113
(651) 855-2109
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R1423754
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
928198300
—
MN
Enumeration date
02/22/2006
Last updated
08/10/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us