Provider Demographics
NPI:1972609410
Name:ROSSI, GWYNETTA HURST (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GWYNETTA
Middle Name:HURST
Last Name:ROSSI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 MUSTANG LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3577
Mailing Address - Country:US
Mailing Address - Phone:713-824-6568
Mailing Address - Fax:
Practice Address - Street 1:2424 W HOLCOMBE ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:302-744-7181
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0141OtherBLUE CROSS BLUE SHIELD
TX8Y0140OtherBLUE CROSS BLUE SHIELD