Provider Demographics
NPI:1780337931
Name:GOSSELIN, IVY MARIE (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:MARIE
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:363 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2714
Mailing Address - Country:US
Mailing Address - Phone:781-541-0206
Mailing Address - Fax:
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6235
Practice Address - Fax:978-937-6941
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2286036163W00000X
MA148515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse