Provider Demographics
NPI:1114494341
Name:GOTSCHALL, NICHOLAS (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GOTSCHALL
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 LIPPINCOTT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:44625-9704
Mailing Address - Country:US
Mailing Address - Phone:330-205-3450
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023755363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care