Healthcare Provider Details

I. General information

NPI: 1477465342
Provider Name (Legal Business Name): MEGAN ROSE GOTTSACKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 W ENON RD
XENIA OH
45385-8548
US

IV. Provider business mailing address

2201 RIVERSIDE DR APT 211
COLUMBUS OH
43221-4041
US

V. Phone/Fax

Practice location:
  • Phone: 937-272-4925
  • Fax:
Mailing address:
  • Phone: 513-503-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number495059
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: