Individual provider · Type 1 NPI

Jacqueline M. Gustafson, CPNP

Pediatric Nurse Practitioner · Minneapolis, MN

NPI number 1760457527 Active

Practice location

2525 Chicago Ave S, Childrens Specialty Clinic Feeding Clinic Mpls
Minneapolis, MN 55404

Call (651) 220-6446 Map

Fax (651) 220-6860

Mailing address

2910 Centre Pointe Dr, 35-121A Childrens Health Care
Roseville, MN 55113

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200XR1423754 (MN)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1760457527

Jacqueline M. Gustafson, CPNP's National Provider Identifier is 1760457527, issued on Feb 22, 2006. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Minneapolis, MN. The record was last updated on Aug 10, 2015.