Provider Demographics
NPI:1699923490
Name:GUSTINA, RACHEL J (NP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:J
Last Name:GUSTINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 RUMSEY ST. EXTENSION
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7827
Mailing Address - Country:US
Mailing Address - Phone:607-776-7651
Mailing Address - Fax:607-664-1020
Practice Address - Street 1:7009 RUMSEY ST. EXTENSION
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7827
Practice Address - Country:US
Practice Address - Phone:607-776-7651
Practice Address - Fax:607-664-1020
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301206363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health