Healthcare Provider Details

I. General information

NPI: 1003311630
Provider Name (Legal Business Name): MESSANVI M GOZO CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 DUTCHMANS LN
EASTON MD
21601-3346
US

IV. Provider business mailing address

811 MIDDLE RIVER RD
MIDDLE RIVER MD
21220-3766
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2343
  • Fax: 844-332-3891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR215546
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: