Provider Demographics
NPI:1760099642
Name:GUSTAFSON, LINDSEY RUTH (NP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RUTH
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 MEADOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3771
Mailing Address - Country:US
Mailing Address - Phone:630-886-7896
Mailing Address - Fax:
Practice Address - Street 1:2054 MEADOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3771
Practice Address - Country:US
Practice Address - Phone:630-886-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily