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General NPI Number Information
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NPI Number | 1114155918
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Entity Type | Individual
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Provider Name | CHRISTINA A GOSSLIN LMP
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 365 RENTON CENTER WAY SW STE F
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City | RENTON
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State | WA
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Zip | 98057-2324
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Country | US
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Telephone | 425-226-7061
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Fax | 425-226-7063
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Provider Business Mailing Address
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Address Line | 3624 NE 7TH ST
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City | RENTON
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State | WA
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Zip | 98056-3843
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Country | US
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Telephone | 206-427-1141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00025174
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License Number State | WA
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