Doctor Name: | MS. ANN MARIE GUSTAFSON-LARSON |
NPI Number: | 1952420333 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, CNP |
License Number: | 1134 |
Business Practice Address: | 1900 Centra Care Circle #2500 Centra Care Clinic Health Plaza / Endocrinology St Cloud, MN - 563035000 |
Business Phone Number: | 3202295000 |
Business Fax Number: | |
Mailing Address: | 1900 Centra Care Circle #2500, Centra Care Clinic Health Plaza / Endocrinology ST CLOUD |
State: | MN |
Postal Code: | 563035000 |
Phone Number: | 3202295000 |
Fax Number: | 7636897878 |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 09/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 1134 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |