Healthcare Provider Details

I. General information

NPI: 1457524407
Provider Name (Legal Business Name): MRS. DEBRA LEE GOSINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 SAGAMORE AVE
PORTSMOUTH NH
03801-5503
US

IV. Provider business mailing address

1145 SAGAMORE AVE
PORTSMOUTH NH
03801-5503
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-6703
  • Fax: 603-430-3753
Mailing address:
  • Phone: 603-431-6703
  • Fax: 603-430-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: