Provider Demographics
NPI:1033819057
Name:GOSSARD, DARLA
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:GOSSARD
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 1:33 KYLE DR
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-4501
Mailing Address - Country:US
Mailing Address - Phone:419-604-1438
Mailing Address - Fax:
Practice Address - Street 1:33 KYLE DR
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-4501
Practice Address - Country:US
Practice Address - Phone:419-604-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant