Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 01075298A | IN |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD60757392 | WA |
NPI | 1083840565 |
---|---|
Provider Name | Dr. Cheryl Janene Gustafson |
First Address | Seattle, WA 98124-0325 |
Second Address | Seattle, WA 98105-4028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2084320 | (05) | WA |