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NPI Code Detail

MEDICARE: DEBRA JEAN GUSTAFSON ARNP

MEDICARE:   DEBRA JEAN GUSTAFSON  ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerF083427IA

General Provider Information

NPI Number : 1447389028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA JEAN GUSTAFSON ARNP
Provider Business Mailing Address
First Line : 1205 BROADWAY ST
Second Line :
City : PELLA
State : IA
Zip : 50219-1231
Country : US
Telephone Number : 319-551-6770
Fax Number :
Provider Business Practice Location Address
First Line : 1720 WATERFRONT DR
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-4414
Country : US
Telephone Number : 319-339-4475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 07/08/2007

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