Basic Information
| Provider Information | |||||||||
| NPI: | 1093990517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOSSETT | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOSSETT | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 498 | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515660498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7126237000 | ||||||||
| FaxNumber: | 7128262052 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | VILLISCA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508641146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7128264422 | ||||||||
| FaxNumber: | 7128262052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2008 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | R687235 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 364SF0001X | A129234 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
ID Information
| ID | Type | State | Issuer | Description | 129234 | 01 | IA | IOWA BOARD OF NURSING LICENSE, REGISTERED NURSE | OTHER | MG2489587 | 01 | CONTROLLED SUBSTANCES REGISTRATION CERTIFICATE | OTHER |