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1922405059
LESLIE GUSTAFSON
LAKE OSWEGO, OR
NPI
1922405059
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: OR PA170542)
Enumeration Date
2014-12-04
Last Update Date
2021-02-12
Business Address
LESLIE GUSTAFSON PA-C
17550 PROVOST ST STE 201
LAKE OSWEGO, OR 97034-5199
Phone number: 503-872-2440
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Mailing Address
LESLIE GUSTAFSON PA-C
PO BOX 3158
PORTLAND, OR 97208-3158
Phone number: 503-215-6494
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