Individual
LANE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(509) 703-2183
Mailing address
643 W NICKERSON ST, SEATTLE, WA 98119-1574
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
RN1355886
WA
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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