Individual
JUDITH LYNN GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 543-7271
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 543-7271
(406) 329-2659
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
21661
MT
363LF0000X
Family Nurse Practitioner
Primary
NUR-APRN-LIC-100250
MT
Other
Enumeration date
07/03/2008
Last updated
05/25/2021
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