Healthcare Provider Details

I. General information

NPI: 1023395274
Provider Name (Legal Business Name): ALLISON C. GOSSAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E BROWN ST IMMEDIATE CARE CENTER
EAST STROUDSBURG PA
18301-3006
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3700
  • Fax: 570-476-3637
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: