Provider Demographics
NPI:1871925446
Name:GUSTAFSON, MARIA LAURA (INTERPRETER/ TRANSLA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LAURA
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:INTERPRETER/ TRANSLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 WESLEYAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-7530
Mailing Address - Country:US
Mailing Address - Phone:779-423-7331
Mailing Address - Fax:
Practice Address - Street 1:3208 WESLEYAN AVE.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108
Practice Address - Country:US
Practice Address - Phone:779-423-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1507171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter