Provider Demographics
NPI:1073497806
Name:GUSTINE, CHANTAL (RN)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:GUSTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 33RD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2334
Mailing Address - Country:US
Mailing Address - Phone:406-270-4447
Mailing Address - Fax:
Practice Address - Street 1:1187 33RD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2334
Practice Address - Country:US
Practice Address - Phone:406-270-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1698448163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical