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General NPI Number Information
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NPI Number | 1750593927
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Entity Type | Individual
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Provider Name | CHARLES GOSHEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 1101 W LIBERTY ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1921
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Country | US
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Telephone | 573-756-6751
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 TRAILRIDGE DR
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City | JACKSON
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State | MO
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Zip | 63755-3507
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Country | US
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Telephone | 735-429-2251
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 110789
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License Number State | MO
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