Provider Demographics
NPI:1558843458
Name:GOSNELL, ROXANNE (AGNP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:FRANCIS
Other - Last Name:KOEBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 HASSEL RICE DR
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-4500
Mailing Address - Country:US
Mailing Address - Phone:828-380-9064
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:828-380-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010949363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology