Most Relevant Information
Provider Data
| NPI Number: | 1003392515 |
| Provider Name: | ALAN KEITH GUSTAFSON |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/17/2018 |
| Last Updated: | 07/17/2018 |
Provider Practice Location
4890 32ND AVE SE
SALEM
OR
973179350
Practice Location Phone/Fax
| Phone: | 5035885647 |
| Fax: | 5037791992 |
Provider Mailing Location
4890 32ND AVE SE
SALEM
OR
973179350
Provider Mailing Phone/Fax
| Phone: | 5035885647 |
| Fax: | 5037791992 |