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Kristin Margaret Gustavson

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

10625 W North Ave Ste 101b, Wauwatosa, WI 53226-2315

PECOS Enrollment

This provider is enrolled in PECOS as KRISTIN GUSTAVSON.

Based on the most recent information from CMS, provider Kristin Margaret Gustavson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1598459117
Provider Type
Individual
Full Name
Gustavson, Kristin Margaret
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/6/2023
Last Updated
6/6/2023

Contact Information

Practice Location

10625 W North Ave Ste 101b, Wauwatosa, WI 53226-2315

(414) 877-5350

Unlisted Fax

Mailing Location

1805 Shepherd Ct Apt 111, Waukesha, WI 53186-1459

(269) 365-4444

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Kristin Margaret Gustavson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Townsend, Katherine

Loftis, Patrick

Christen, Kathryn

Hagen, Demi Elisabeth

Wilkins, Karly D

Carroll, Emily

Kapla, Trent

Koller, Mikaela J

Nordquist, Haylie Brynne Hansen

Cortez, Olivia