Individual
JODY GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 GINKGO ST S, SOAP LAKE, WA 98851-9166
(509) 246-1323
(509) 246-0669
Mailing address
11367 ROAD B.2 NW, EPHRATA, WA 98823-7809
(509) 246-1323
(509) 246-0669
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
60720556
WA
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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