Jody Gustafson
Individual provider Active NPI Registered Nurse · Soap Lake, WA
NPI 1922945583 · NPPES record last updated May 1, 2026
Key facts
- NPI
- 1922945583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 60720556 (WA)
- Practice address
- 410 Ginkgo St S
Soap Lake, WA 98851-9166 - Phone
- (509) 246-1323
- Fax
- (509) 246-0669
- NPI assigned
- May 1, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60720556 | WA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 60720556 | WA | Yes |
Addresses
Primary practice location
410 Ginkgo St S
Soap Lake, WA 98851-9166
Mailing address
11367 Road B.2 NW
Ephrata, WA 98823-7809
Phone (509) 246-1323
Other providers in Soap Lake, WA
- Michelle R Agliano
- Joe Barbee
- Amanda L. Chapel
- Erica Gaertner
- Grant County Fire Protection District 7
- Jesse D Hannaford
- Alissa Rose Herbst
- Kandice Krause
- Mary Lou Langley
- Eldon Lester Leinweber
All providers in Soap Lake, WA · Registered Nurse in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.