Provider Demographics
NPI:1093990517
Name:GOSSETT, DENISE W (FNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:W
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:DENISE
Other - Last Name:GOSSETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0498
Mailing Address - Country:US
Mailing Address - Phone:712-623-7000
Mailing Address - Fax:712-826-2052
Practice Address - Street 1:301 E 4TH ST
Practice Address - Street 2:
Practice Address - City:VILLISCA
Practice Address - State:IA
Practice Address - Zip Code:50864-1146
Practice Address - Country:US
Practice Address - Phone:712-826-4422
Practice Address - Fax:712-826-2052
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR687235364SF0001X
IAA129234364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA129234OtherIOWA BOARD OF NURSING LICENSE, REGISTERED NURSE
MG2489587OtherCONTROLLED SUBSTANCES REGISTRATION CERTIFICATE
MG2489587OtherCONTROLLED SUBSTANCES REGISTRATION CERTIFICATE