LYNN K GUSTAFSON (NPI# 1124006143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124006143 |
| Entity Type | Individual |
| Full Name | LYNN K GUSTAFSON |
| Credential | DPM |
| Practice Address |
1421 Premiere Dr Mankato Clinic @ Wickersham Campus Mankato MN 56001 |
| Mailing Address |
Po Box 8674 1230 E Main St Mankato MN 56002-8674 |
| Practice Telephone | 5076251811 |
| Mailing Telephone | 5076251811 |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2020-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 492 | MN | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AMERICA'S PPO (MN) | 1753435 | 01 | |
| UCARE (MN) | 115542 | 01 | |
| BCBS (MN) | 1M845GU | 01 | |
| RR MEDICARE | 480018263 | 01 | |
| MEDICAID (IOWA) | 937961 | 01 | |
| MEDICA (MN) | 2700674 | 01 | |
| PREFERRED ONE (MN) | NA2951011002 | 01 | |
| MN | 704325200 | 05 | |
| HEALTH PARTNERS (MN) | HP26296 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801030515 | Lynn Gustafson | Counselor | 414-416 Allegheny River Blvd, Sutie 201, Oakmont, PA 15139-1754 | 2009-04-24 |
| Street Address |
1421 PREMIERE DR MANKATO CLINIC @ WICKERSHAM CAMPUS |
| City | MANKATO |
| State | MN |
| Zip Code | 56001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013995034 | Gary S Goldberg | Urology | 1421 Premiere Dr, Mankato Clinic@ Wickersham Campus, Mankato, MN 56001-6076 | 2006-01-09 |
| 1205816287 | John W Benson | Family Medicine | 1421 Premiere Dr, Mankato Clinic At Wickersham, Mankato, MN 56001-6076 | 2006-01-18 |
| 1215916218 | Michael C James | Urology | 1421 Premiere Dr, Mankato Clinic At Wickersham Campus, Mankato, MN 56001-6076 | 2006-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935435 | Kelly Nicole Ricke | Physical Medicine & Rehabilitation | 1 Civic Center Plaza, Hockey Office Complex, Mankato, MN 56001 | 2020-09-03 |
| 1649816786 | Ashley Lynn Walters | Technician, Other | 501 Madison Ave., Mankato, MN 56001 | 2019-11-25 |
| 1720631716 | Dovetail Traslation LLC | Interpreter | 212 Dublin Ct, Same As Above, Mankato, MN 56001 | 2019-07-19 |
| 1093377871 | Lindsey Keithahn | Counselor | 2100 Bassett Drive, Mankato, MN 56001 | 2019-07-02 |
| 1255803813 | Amy Marie Williams | Acupuncturist | 709 S. Front Street, Suite 5, Mankato, MN 56001 | 2018-12-20 |
| 1518437573 | Ashley Blanchard | Acupuncturist | Vida Salon Suites 1351 Madison Avenue, Suite F/ Suite 206, Mankato, MN 56001 | 2018-12-03 |
| 1831687235 | Christian Goetz | Specialist/Technologist | 401-477 South Rd, Mankato, MN 56001 | 2018-05-01 |
| 1366949141 | Minnesota State College and Universities | Specialist/Technologist | 135 Myers Field House, Mankato, MN 56001 | 2018-04-09 |
| 1780191775 | Kevin David Nelson | Pharmacist | 111 Redtail Ct Apt 308, Mankato, MN 56001 | 2017-12-29 |
| 1972014231 | Rylee Wagner | Speech-Language Pathologist | Mankato Clinic Pediatric Therapy Services, 150 St. Andrews Court, Suite 310, Mankato, MN 56001 | 2017-10-13 |
| Find all providers in zip 56001 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417057084 | James Sidney Shaw | Podiatrist | 65 Teton Ln, Mankato, MN 56001-4814 | 2006-09-24 |
| 1689653685 | James D Nack | Podiatrist | 1421 Premier Dr, Mankato Clinic @ Wickersham Campus, Mankato, MN 56002-8674 | 2006-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912556937 | Seniorwell Pod of Minnesota, LLC | Podiatrist | 100 S 5th St Ste 1900, Minneapolis, MN 55402-1267 | 2019-09-11 |
| 1033553789 | Advanced Foot & Ankle Clinic LLP | Podiatrist | 633 1st St Se Ste 100, Faribault, MN 55021-6348 | 2013-04-24 |
| 1881963239 | Foot Care Across America, LLC | Podiatrist | 14654 Rhinestone Terrace, Ramsey, MN 55303-4923 | 2011-12-14 |
| 1083902126 | Paul H Peterson | Podiatrist | 1420 109th Ave Ne Ste 100, Blaine, MN 55449-3603 | 2011-07-11 |
| 1619261708 | Nathan D Sanders | Podiatrist | 404 West Fountain Street, Albert Lea, MN 56007-3920 | 2011-06-06 |
| 1427352087 | Doctors By Your Side | Podiatrist | 6600 Lyndale Av S, #120, Richfield, MN 55423-3398 | 2010-12-22 |
| 1154566396 | Sarah Phelps Whittaker | Podiatrist | 2221 Ford Parkway, Suite #350, Saint Paul, MN 55116-3837 | 2008-12-02 |
| 1568635969 | Bolcer Podiatry, Inc. | Podiatrist | 19230 Evans St Nw Ste 109, Elk River, MN 55330-1079 | 2008-04-07 |
| 1194846782 | Range Podiatric Care, Pa | Podiatrist | 809 N 6th Ave, Northgate Plaza, Virginia, MN 55792-2308 | 2007-04-02 |
| 1285779991 | John Tyler Garner | Podiatrist | 2302 Highway 53, Eveleth, MN 55734-8523 | 2007-02-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.