Active NPI
Vicky Kay Gustafson, REGISTERED NURSE
- Registered Nurse
- Moreno Valley, CA
National Provider Identifier
1487879854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 363657
- Practice address
- 14174 Vincente Dr
Moreno Valley, CA 92553-3505 - Phone
- (951) 924-5551
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 363657 | CA | Primary |
Addresses
Primary practice location
14174 Vincente Dr
Moreno Valley, CA 92553-3505
Mailing address
124174 Vincente Drive
Moreno Valley, CA 92553
Phone (951) 924-5551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 363657 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487879854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124174 VINCENTE DRIVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "92553",
"telephone_number": "951-924-5551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14174 VINCENTE DR",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925533505",
"telephone_number": "951-924-5551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "VICKY",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "363657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.