Provider Demographics
NPI:1487425344
Name:GUST, BETH ANN (LPN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GUST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 DRAYTON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-7526
Mailing Address - Country:US
Mailing Address - Phone:912-651-2587
Mailing Address - Fax:912-651-2875
Practice Address - Street 1:1602 DRAYTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-7526
Practice Address - Country:US
Practice Address - Phone:912-651-2587
Practice Address - Fax:912-651-2875
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN100782164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse