Healthcare Provider Details

I. General information

NPI: 1275965329
Provider Name (Legal Business Name): SARA BETH GOSSETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA LENNON PA

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W OGDEN AVE
HINSDALE IL
60521-3186
US

IV. Provider business mailing address

550 W OGDEN AVE
HINSDALE IL
60521-3186
US

V. Phone/Fax

Practice location:
  • Phone: 630-323-6116
  • Fax: 630-323-6169
Mailing address:
  • Phone: 630-323-6116
  • Fax: 630-323-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085-004769
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085004769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: