Provider Demographics
NPI:1326523267
Name:GOWER, JOCELYN (LPN)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:GOWER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BRICKER ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2423
Mailing Address - Country:US
Mailing Address - Phone:419-619-5787
Mailing Address - Fax:
Practice Address - Street 1:22 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-9399
Practice Address - Country:US
Practice Address - Phone:419-983-4100
Practice Address - Fax:419-983-4103
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse