Provider Demographics
NPI:1851002059
Name:GOSSMAN, MEGAN D (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:GOSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DREW AVE SE
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1841
Mailing Address - Country:US
Mailing Address - Phone:507-642-3255
Mailing Address - Fax:
Practice Address - Street 1:121 DREW AVE SE
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1841
Practice Address - Country:US
Practice Address - Phone:507-642-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily