Provider Demographics
NPI:1609996370
Name:GOSSETT, LINDA LOUISE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOUISE
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 MARTINA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5296
Mailing Address - Country:US
Mailing Address - Phone:815-633-7328
Mailing Address - Fax:815-633-9673
Practice Address - Street 1:4008 MARTINA DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5296
Practice Address - Country:US
Practice Address - Phone:815-633-7328
Practice Address - Fax:815-633-9673
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse