Provider Demographics
NPI:1245964113
Name:GUST, CARLEEN MARGARET (AGNP-C)
Entity type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:MARGARET
Last Name:GUST
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 37TH AVE SW STE B
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7301
Mailing Address - Country:US
Mailing Address - Phone:701-255-3311
Mailing Address - Fax:
Practice Address - Street 1:305 37TH AVE SW STE B
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7301
Practice Address - Country:US
Practice Address - Phone:701-255-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27879163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery