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Contact Information

LYNN K GUSTAFSON, DPM
1421 PREMIERE DR
MANKATO CLINIC @ WICKERSHAM CAMPUS
MANKATO, MN56001
 Phone: 507-625-1811
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for LYNN K GUSTAFSON · (Female)

NPI # 1124006143
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 01/09/2006
Last updated 07/10/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • MN License # 492
  • MN Medicaid 704325200
  • Other 1753435 AMERICA'S PPO (MN)
  • Other 1M845GU BCBS (MN)
  • Other HP26296 HEALTH PARTNERS (MN)
  • Other 2700674 MEDICA (MN)
  • Other 937961 MEDICAID (IOWA)
  • Other NA2951011002 PREFERRED ONE (MN)
  • Other 480018263 RR MEDICARE
  • Other 115542 UCARE (MN)
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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