Provider Demographics
NPI:1013170943
Name:GOSNELL, BETTY DEAN
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:DEAN
Last Name:GOSNELL
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 1:25 LITTLE BEND LN
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-9350
Mailing Address - Country:US
Mailing Address - Phone:828-883-8581
Mailing Address - Fax:828-883-8581
Practice Address - Street 1:25 LITTLE BEND LN
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-9350
Practice Address - Country:US
Practice Address - Phone:828-883-8581
Practice Address - Fax:828-883-8581
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-088-0043747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider