Mallory Lynn Gustin, APRN, CNP
Nurse Practitioner, Adult Health in Annandale, MN. Individual provider (NPI-1).
NPI number1437542016
StatusActive
Last updated in NPPESJun 20, 2024
Details
- NPI
- 1437542016
- Entity type
- Individual (NPI-1)
- Name
- Ms. Mallory Lynn Gustin
- Credential
- APRN, CNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 6, 2015
- Certification date
- Jun 20, 2024
- Last updated
- Jun 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2200X | Nurse Practitioner, Adult Health | CNP 3741 | MN | Yes |
| 363LG0600X | Nurse Practitioner, Gerontology | CNP 3741 | MN |
Practice location
440 Elm St EAnnandale, MN 55302-1109
Phone 320-274-3744 · Fax 320-274-8194
Mailing address
2925 Chicago AveMinneapolis, MN 55407-1321
Phone 612-262-9000
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