Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1190 | NV |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | L5358 | TX |
NPI | 1285632133 |
---|---|
Provider Name | Sharon M Gustowski |
First Address | Conroe, TX 77304-3320 |
Second Address | Conroe, TX 77304-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
284748501 | (05) | TX |
8CX870 | BCBS (01) | TX |
I43237 | (02) | NV |
P00978115 | RAILROAD MEDICARE (01) | TX |