Gust, Jackie

Gust, Jackie is an individual health care provider with primary practice located at 421 Sw Oak St #210, Portland OR 97204-1817. She recently has only one registered license in Nursing Service Providers / Community Health, which is considered as her primary health care specialty. Gust, Jackie can be contacted via phone (503) 988-3056.

Contact Information

Primary practice address
421 Sw Oak St #210 Portland OR 97204-1817
Phone: (503) 988-3056
Fax: (503) 988-3015
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Community Health 163WC1500X 078041151RN Oregon

Profile Details

NPI number 1235367921
LBN Legal business name Gust, Jackie
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2009
Last updated Jul 1st, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235367921 NPPES
Oregon MEDICAID 096511
Oregon MEDICAID 022959

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