Provider Demographics
NPI:1760827968
Name:GUSTASON, CAROLYN JOAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JOAN
Last Name:GUSTASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:JOAN
Other - Last Name:CASAGRANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:20 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4636
Mailing Address - Country:US
Mailing Address - Phone:978-537-9848
Mailing Address - Fax:
Practice Address - Street 1:20 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4636
Practice Address - Country:US
Practice Address - Phone:978-537-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN216767163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology