Gregory Robert Gustavson, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

92342 Issued in CT

Practice address

112 Mansfield Ave
Willimantic, CT 06226-2040

Phone

(860) 456-9116

NPI assigned

Jun 16, 2026

Last updated

Aug 18, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Greg Robert Gustavson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1781568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1770418030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BEAUDET TER",
            "city": "COLUMBIA",
            "state": "CT",
            "postal_code": "062371404",
            "telephone_number": "860-617-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MANSFIELD AVE",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262040",
            "telephone_number": "860-456-9116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 Lewis Ave",
            "address_purpose": "LOCATION",
            "city": "Meriden",
            "state": "CT",
            "postal_code": "064512101",
            "country_code": "US",
            "telephone_number": "203-694-8928",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "326 Washington St",
            "address_purpose": "LOCATION",
            "city": "Norwich",
            "state": "CT",
            "postal_code": "063602740",
            "country_code": "US",
            "telephone_number": "860-889-8331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Grand St",
            "address_purpose": "LOCATION",
            "city": "New Britain",
            "state": "CT",
            "postal_code": "060522016",
            "country_code": "US",
            "telephone_number": "860-276-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "GREGORY",
        "middle_name": "ROBERT",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-06-16",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CT",
            "license": "92342",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CT",
            "license": "92342",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CT",
            "license": "12.017664",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GREG",
            "last_name": "GUSTAVSON",
            "middle_name": "ROBERT",
            "credential": "APRN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steven J Green, MD
• Jasminka Hasan Grgas, LPC
• Christian Jay Griffin, RPH
• Lisa-Marie W Griffiths, APRN
• Kelly Guertin
• Kelli Gustavson
• Marc L. Guttman, M.D.
• Rebekah Hafford, MSW
• Toysha D Haley
• Gregory Haman, M.D.

• Acute Care Nurse Practitioner in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Acute Care Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.