Provider Demographics
NPI:1619692241
Name:GOSS, BEVERLY ELAINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:GOSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 BARNES AVE PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3209
Mailing Address - Country:US
Mailing Address - Phone:914-434-5111
Mailing Address - Fax:
Practice Address - Street 1:1927 BARNES AVE PH
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3209
Practice Address - Country:US
Practice Address - Phone:914-434-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300117-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse