Individual provider · Type 1 NPI

Wallace Ann Gustafson, MAP, MA

Student in an Organized Health Care Education/Training Program · Hartford, CT

NPI number 1972212959 Active

Practice location

331 Wethersfield Ave
Hartford, CT 06114-1420

Call (860) 236-4511 Map

Mailing address

PO Box 567
Willmar, MN 56201-0567

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1972212959

Wallace Ann Gustafson, MAP, MA's National Provider Identifier is 1972212959, issued on Nov 18, 2022. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Hartford, CT. The record was last updated on Nov 18, 2022.