MEDICARE: MS. BRIDGETTE KATHRYN GOSSETT LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN105566	OH

General Provider Information

NPI Number	:	1801856315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGETTE KATHRYN GOSSETT LPN

Provider Business Mailing Address
First Line	:	620 WOODSIDE AVE NE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2036
Country	:	US
Telephone Number	:	330-966-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 WOODSIDE AVE NE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2036
Country	:	US
Telephone Number	:	330-966-7527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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