Gustavison, Casey L

Gustavison, Casey L is an individual health care provider with primary practice located at 409 W Oak St , Carbondale IL 62901-1464. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Gustavison, Casey L can be contacted via phone (618) 529-4455.

Contact Information

Primary practice address
409 W Oak St Carbondale IL 62901-1464
Phone: (618) 529-4455
Fax: (618) 351-1287
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209008417 Illinois

Profile Details

NPI number 1508004706
LBN Legal business name Gustavison, Casey L
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2009
Last updated Oct 30th, 2020 - about 5 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 1508004706 NPPES
Indiana Other 71002863B CSR
Indiana MEDICAID PENDING CSR
Indiana Other 71002863A CSR

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