Gustafson, Lesley A
Gustafson, Lesley A is an individual health care provider with primary practice located at 140 Grandview Ave Suite 202, Waterbury CT 06708. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Gustafson, Lesley A can be contacted via phone (203) 755-2344.Contact Information
Primary practice address
140 Grandview Ave Suite 202
Waterbury CT 06708
Phone: (203) 755-2344
Fax: (203) 573-8166
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife | 367A00000X | 114 | West Virginia |
| Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife | 367A00000X | 57006 | West Virginia |
Profile Details
| NPI number | 1639163199 |
|---|---|
| LBN Legal business name | Gustafson, Lesley A |
| Credentials | Certified Nurse Midwife (CNM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 9th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639163199 | NPPES |
| West Virginia | MEDICAID | 9450001000 |
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