Healthcare Provider Details

I. General information

NPI: 1790738573
Provider Name (Legal Business Name): DEBORAH L GOSNELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S MAIN ST
SANDY LAKE PA
16145
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-376-7111
  • Fax: 724-376-7165
Mailing address:
  • Phone: 724-376-7111
  • Fax: 724-376-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP004408B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: