National Provider Identifier
Susan E Gustafson, PA-C
Susan E Gustafson, PA-C is listed in the NPPES registry with a primary specialty of Physician Assistant in Jamestown, NY and a listed phone number of (716) 664-1909.
Profile Overview
- NPI
- 1417393927
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- May 13, 2013
- Last Updated
- August 20, 2021
Practice Location
- 21 Porter Ave
- Jamestown, NY 14701-6247
Phone: (716) 664-1909
Specialties
- Physician Assistant (363A00000X)
- Medical Physician Assistant (363AM0700X)
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1417393927
- Entity Type
- Individual
- Last Name
- Gustafson
- First Name
- Susan
- Middle Name
- E
- Credential
- PA-C
- Provider Other Last Name
- Bentley
- Provider Other First Name
- Susan
- Provider Other Middle Name
- E
- Provider Other Credential Text
- PA-C
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 21 Porter Ave
- Mailing City
- Jamestown
- Mailing State
- NY
- Mailing ZIP Code
- 14701-6247
- Mailing Country
- US
- Mailing Phone
- (716) 664-1909
- Mailing Fax
- (716) 664-2214
- Practice Street Address
- 21 Porter Ave
- Practice City
- Jamestown
- Practice State
- NY
- Practice ZIP Code
- 14701-6247
- Practice Country
- US
- Practice Phone
- (716) 664-1909
- Practice Fax
- (716) 664-2214
- Enumeration Date
- May 13, 2013
- Last Updated
- August 20, 2021
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- August 20, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X), Medical Physician Assistant (363AM0700X), Physician Assistant (363A00000X)