Healthcare Provider Details

I. General information

NPI: 1093118770
Provider Name (Legal Business Name): CHASIDY GOERSMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3447 CLOVER DR
BRUNSWICK OH
44212-3106
US

IV. Provider business mailing address

3447 CLOVER DR
BRUNSWICK OH
44212-3106
US

V. Phone/Fax

Practice location:
  • Phone: 330-461-1616
  • Fax:
Mailing address:
  • Phone: 330-461-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: