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NPI Code Detail

MEDICARE: MS. REBA J GOSHERT NP

MEDICARE: MS. REBA J GOSHERT NP
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
1363LP0200XPediatric Nurse Practitioner71000002AIN

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 : 1912103151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBA J GOSHERT NP
Provider Business Mailing Address
First Line : 710 N NILES AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-1924
Country : US
Telephone Number : 574-647-1610
Fax Number : 574-237-6069
Provider Business Practice Location Address
First Line : 2102 N MAIN ST
Second Line :
City : NAPPANEE
State : IN
Zip : 46550-9310
Country : US
Telephone Number : 574-862-2165
Fax Number : 574-862-4112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 04/28/2023

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