MEDICARE: ARICA LYNNE GOGOL NURSE PRACTITIONER

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
1	207Q00000X	Family Medicine Physician	0037562	OH
2	363LF0000X	Family Nurse Practitioner	0024176261	VA

General Provider Information

NPI Number	:	1548756505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARICA LYNNE GOGOL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	166 LAWAI RD
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-2522
Country	:	US
Telephone Number	:	419-290-8612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1119 N MILITARY HWY
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2415
Country	:	US
Telephone Number	:	757-240-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	10/30/2024

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