Provider Demographics
NPI:1417532797
Name:GOSWICK, LEAH ENOCHS
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ENOCHS
Last Name:GOSWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 OLD WOODLEY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-2117
Mailing Address - Country:US
Mailing Address - Phone:903-926-3320
Mailing Address - Fax:
Practice Address - Street 1:537 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5919
Practice Address - Country:US
Practice Address - Phone:318-560-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN120953163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics