Individual
BRANDON JAMES GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
228 WIECKING CTR, MANKATO, MN 56001-6062
(507) 389-1866
Mailing address
10220 PALM ST NW, COON RAPIDS, MN 55433-5139
(763) 439-0947
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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