Provider Demographics
NPI:1366223729
Name:GUSTAFSON, MEAGHAN L (MSN, RN, FNP-C)
Entity type:Individual
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First Name:MEAGHAN
Middle Name:L
Last Name:GUSTAFSON
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Gender:F
Credentials:MSN, RN, FNP-C
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Mailing Address - Street 1:2024 MAIDEN LANE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-659-4661
Mailing Address - Fax:417-659-8509
Practice Address - Street 1:2024 MAIDEN LANE
Practice Address - Street 2:SUITE 203
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-659-4661
Practice Address - Fax:417-659-8509
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2023041153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily