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NPI Code Detail

MEDICARE: TODD RICHARD GUSTAFSON CRNA

MEDICARE: TODD RICHARD GUSTAFSON CRNA
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
1367500000XCertified Registered Nurse Anesthetist1659SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770560021
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD RICHARD GUSTAFSON CRNA
Provider Business Mailing Address
First Line : 310 FALLEN OAK
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-8934
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1315 ROBERTS ST
Second Line :
City : CAMDEN
State : SC
Zip : 29020-3737
Country : US
Telephone Number : 803-432-4311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 07/09/2007

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