Provider Demographics
NPI:1790738573
Name:GOSNELL, DEBORAH L (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-376-7111
Mailing Address - Fax:724-376-7165
Practice Address - Street 1:3205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145
Practice Address - Country:US
Practice Address - Phone:724-376-7111
Practice Address - Fax:724-376-7165
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004408B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000517675OtherANTHEM BCBS
PA089816Medicare ID - Type Unspecified
P07909Medicare UPIN
OH000000517675OtherANTHEM BCBS