| Doctor Name: | AMBER JOY GUSTAFSON |
| NPI Number: | 1063669778 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 5601005343 |
| Business Practice Address: | 2845 Us 2 & 41 Suite 201 Bark River, MI - 49807 |
| Business Phone Number: | 9064662000 |
| Business Fax Number: | 9064662067 |
| Mailing Address: | 2845 Us 2 & 41, Suite 201 BARK RIVER |
| State: | MI |
| Postal Code: | 49807 |
| Phone Number: | 9064662000 |
| Fax Number: | 9064662067 |
| NPI Enumeration Date: | 08/25/2008 |
| NPI Last Update Date: | 03/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601005343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |