Provider Demographics
NPI:1750300984
Name:GOSSETT, SHARON E
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 E LUPINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2247
Mailing Address - Country:US
Mailing Address - Phone:602-765-8271
Mailing Address - Fax:
Practice Address - Street 1:4106 E LUPINE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-2247
Practice Address - Country:US
Practice Address - Phone:602-765-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ49435Medicare UPIN
AZ104639Medicare ID - Type Unspecified