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NPI Code Detail

MEDICARE: DR. WENDY JO GOSNELL MD

MEDICARE: DR. WENDY JO GOSNELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician21972NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235212424
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WENDY JO GOSNELL MD
Provider Business Mailing Address
First Line : PO BOX 12855
Second Line :
City : BELFAST
State : ME
Zip : 04915-4019
Country : US
Telephone Number : 617-402-1000
Fax Number : 888-864-4428
Provider Business Practice Location Address
First Line : 210 MCNEEL LN
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-6290
Country : US
Telephone Number : 308-221-6262
Fax Number : 308-221-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 06/28/2016

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