Provider Demographics
NPI:1689822298
Name:GOSILNER, HEATHER ERICA (RN, PHN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:ERICA
Last Name:GOSILNER
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2744
Mailing Address - Country:US
Mailing Address - Phone:415-453-3535
Mailing Address - Fax:
Practice Address - Street 1:273 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2744
Practice Address - Country:US
Practice Address - Phone:415-453-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse