Healthcare Provider Details

I. General information

NPI: 1437143286
Provider Name (Legal Business Name): BETH ANN GUNSELMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN WILSON CNP

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 COOPER FOSTER PARK RD
LORAIN OH
44053
US

IV. Provider business mailing address

5700 COOPER FOSTER PARK RD
LORAIN OH
44053
US

V. Phone/Fax

Practice location:
  • Phone: 440-204-7400
  • Fax: 440-204-7376
Mailing address:
  • Phone: 440-204-7400
  • Fax: 440-204-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN259056
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.06553-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: