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General NPI Number Information
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NPI Number | 1396111597
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Entity Type | Individual
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Provider Name | ADJONDI MARIE GOSSEAUX NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 630 E RIVER ST
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City | ELYRIA
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State | OH
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Zip | 44035-5902
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Country | US
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Telephone | 440-329-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 48419 US HIGHWAY 20
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City | OBERLIN
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State | OH
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Zip | 44074-9488
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Country | US
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Telephone | 440-387-1238
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.021734
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License Number State | OH
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