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General NPI Number Information
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NPI Number | 1851556658
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Entity Type | Individual
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Provider Name | STACEY L GUSMAN APNP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 6 JOHNSON ST
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City | OWEN
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State | WI
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Zip | 54460-9534
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Country | US
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Telephone | 715-229-2177
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Fax | 715-229-4450
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Provider Business Mailing Address
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Address Line | 6 JOHNSON ST
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City | OWEN
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State | WI
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Zip | 54460-9534
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Country | US
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Telephone | 715-229-2177
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Fax | 715-229-4450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3467
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License Number State | WI
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