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General NPI Number Information
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NPI Number | 1861209892
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Entity Type | Individual
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Provider Name | VALARIE LEE GUSTAFSON RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 2600 CLIFTON AVE
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City | CINCINNATI
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State | OH
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Zip | 45220-2872
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Country | US
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Telephone | 513-556-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4341 W HOGAN RD
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City | PENTWATER
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State | MI
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Zip | 49449-9452
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Country | US
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Telephone | 863-446-2227
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Fax |
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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 | 4704301159
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License Number State | MI
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