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NPI Code Detail

MEDICARE: VALARIE LEE GUSTAFSON RN, FNP-C

MEDICARE: VALARIE LEE GUSTAFSON RN, FNP-C
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
1363LF0000XFamily Nurse Practitioner4704301159MI

General Provider Information

NPI Number : 1861209892
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALARIE LEE GUSTAFSON RN, FNP-C
Provider Business Mailing Address
First Line : 4341 W HOGAN RD
Second Line :
City : PENTWATER
State : MI
Zip : 49449-9452
Country : US
Telephone Number : 863-446-2227
Fax Number :
Provider Business Practice Location Address
First Line : 2600 CLIFTON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45220-2872
Country : US
Telephone Number : 513-556-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2024
Last Update Date : 12/12/2024

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