Healthcare Provider Details

I. General information

NPI: 1942513429
Provider Name (Legal Business Name): CYNTHIA G GOSTOMSKI MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S INDUSTRIAL HWY SUITE 75
ANN ARBOR MI
48104-6796
US

IV. Provider business mailing address

14806 MULBERRY ST
SOUTHGATE MI
48195-3700
US

V. Phone/Fax

Practice location:
  • Phone: 734-477-7204
  • Fax:
Mailing address:
  • Phone: 313-929-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberL1708582
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: