Provider Demographics
NPI:1588837538
Name:GOTTSCHALL, JOANNE (RNC, CPM, LM)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:GOTTSCHALL
Suffix:
Gender:F
Credentials:RNC, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 CHEVES DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2606
Mailing Address - Country:US
Mailing Address - Phone:843-764-9678
Mailing Address - Fax:
Practice Address - Street 1:353 CHEVES DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2606
Practice Address - Country:US
Practice Address - Phone:843-764-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07725400163WM0102X
SCRN.216601163W00000X
SCLMW-0054176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0038Medicaid