Healthcare Provider Details

I. General information

NPI: 1477539898
Provider Name (Legal Business Name): SHARON A GOSSMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2005
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 11TH ST
NELIGH NE
68756-1065
US

IV. Provider business mailing address

PO BOX 109
NELIGH NE
68756-0109
US

V. Phone/Fax

Practice location:
  • Phone: 402-887-5440
  • Fax: 402-887-4564
Mailing address:
  • Phone: 402-887-5440
  • Fax: 402-887-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110378
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: