Mallory Lynn Gustin, APRN, CNP
Individual provider Active NPI Adult Health Nurse Practitioner · Annandale, MN
NPI 1437542016 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1437542016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- CNP 3741 (MN)
- Practice address
- 440 Elm St E
Annandale, MN 55302-1109 - Phone
- (320) 274-3744
- Fax
- (320) 274-8194
- NPI assigned
- Mar 6, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Allina Health System
Practice addresses (Care Compare)
440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225
Hospital & facility affiliations
- Allina Health Home Health
- Buffalo Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150504001004 | MN | Practitioner - Nurse Practitioner | 1456670066 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP 3741 | MN | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Past | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
1700 Highway 25 N
Hanover, MN 55313
Phone (763) 682-1313
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
Interoperability endpoints
- manderson81349@direct.northmemorial.com
- mgustin294911@excellian.direct.allina.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | CNP 3741 | MN | |
| Adult Health Nurse Practitioner | 363LA2200X | CNP 3741 | MN | Yes |
Addresses
Primary practice location
440 Elm St E
Annandale, MN 55302-1109
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | manderson81349@direct.northmemorial.com | ||
| Direct Messaging Address | mgustin294911@excellian.direct.allina.com | Direct |
Other providers in Annandale, MN
- Enrichment Therapy Services
- Hannah Margaret Fischer
- Greta Fiskum
- Marcia Lee Froehling
- Ann Gross
- David Gerald Hanson
- Lori Lee Hausken
- Anthony David Hegge
- Eric Richard Heimkes
- Dawn Mae Hill
All providers in Annandale, MN · Adult Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.