Provider Demographics
NPI:1255807335
Name:GOSSARD, MELANIE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:GOSSARD
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 S BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2604
Mailing Address - Country:US
Mailing Address - Phone:937-525-2470
Mailing Address - Fax:937-525-2432
Practice Address - Street 1:362 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2604
Practice Address - Country:US
Practice Address - Phone:937-525-2470
Practice Address - Fax:937-525-2432
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily