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General NPI Number Information
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NPI Number | 1346310067
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Entity Type | Individual
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Provider Name | GREGORY VANFOSSEN N.P.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 862 CALLEN LN NW
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City | CLEVELAND
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State | TN
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Zip | 37312-6995
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Country | US
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Telephone | 423-331-5025
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Fax | 833-450-6211
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Provider Business Mailing Address
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Address Line | 3774 BLUE SPRINGS RD
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City | CLEVELAND
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State | TN
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Zip | 37311-8827
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Country | US
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Telephone | 786-818-9004
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21795
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License Number State | TN
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