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:
Health care specialties
Specialty | Code | License # | 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 4 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 | 1508004706 | NPPES |
Indiana | Other | 71002863B | CSR |
Indiana | MEDICAID | PENDING | CSR |
Indiana | Other | 71002863A | CSR |
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