Provider Demographics
NPI:1447389028
Name:GUSTAFSON, DEBRA JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1231
Mailing Address - Country:US
Mailing Address - Phone:319-551-6770
Mailing Address - Fax:
Practice Address - Street 1:1720 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4414
Practice Address - Country:US
Practice Address - Phone:319-339-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF083427363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health