Provider Demographics
NPI:1467117556
Name:GOSSELIN, MCKAYLA
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:GOSSELIN
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 1:2435 S FORDNEY RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-9777
Mailing Address - Country:US
Mailing Address - Phone:989-992-6230
Mailing Address - Fax:
Practice Address - Street 1:2435 S FORDNEY RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9777
Practice Address - Country:US
Practice Address - Phone:989-992-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other