Provider Demographics
NPI:1316024664
Name:GOSDZINSKI, MELINDA LYNN (RNC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LYNN
Last Name:GOSDZINSKI
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 TYRE RD
Mailing Address - Street 2:
Mailing Address - City:UBLY
Mailing Address - State:MI
Mailing Address - Zip Code:48475-8771
Mailing Address - Country:US
Mailing Address - Phone:989-658-8133
Mailing Address - Fax:
Practice Address - Street 1:120 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1009
Practice Address - Country:US
Practice Address - Phone:810-648-2350
Practice Address - Fax:810-648-4645
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116363163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N39460Medicare ID - Type Unspecified