Provider Demographics
NPI:1437143286
Name:GUNSELMAN, BETH ANN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:GUNSELMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5700 COOPER FOSTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-204-7400
Mailing Address - Fax:440-204-7376
Practice Address - Street 1:5700 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-204-7400
Practice Address - Fax:440-204-7376
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN259056163W00000X
OHCOA.06553-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278084Medicaid
OH0207207Medicaid
OH2278084Medicaid
OHNP18582Medicare PIN
OH9288885Medicare PIN
OH9288884Medicare PIN
OH0207207Medicaid
OH9288887Medicare PIN
OHP39827Medicare UPIN