Healthcare Provider Details

I. General information

NPI: 1326523267
Provider Name (Legal Business Name): JOCELYN GOWER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CLINTON ST
BLOOMVILLE OH
44818-9399
US

IV. Provider business mailing address

207 BRICKER ST
FOSTORIA OH
44830-2423
US

V. Phone/Fax

Practice location:
  • Phone: 419-983-4100
  • Fax: 419-983-4103
Mailing address:
  • Phone: 419-619-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number110347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: