Provider Demographics
NPI:1699363382
Name:GOSTING, JILL KONECNY (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KONECNY
Last Name:GOSTING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2995
Mailing Address - Country:US
Mailing Address - Phone:775-445-7401
Mailing Address - Fax:775-841-0304
Practice Address - Street 1:775 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2995
Practice Address - Country:US
Practice Address - Phone:775-445-7401
Practice Address - Fax:775-841-0304
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN30917163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health