MACKENZIE GUSTAFSON

TWIN FALLS, ID
NPI1669101234
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner Psychiatric/Mental Health
(Licence: ID  59468)
Enumeration Date2022-06-08
Last Update Date2022-08-19
Business Address
MACKENZIE GUSTAFSON PMHNP
414 SHOUP AVE W STE B
TWIN FALLS, ID 83301-5042
Phone number: 208-814-9100
Mailing Address
MACKENZIE GUSTAFSON PMHNP
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number:
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