Provider Demographics
NPI:1124851951
Name:GOSSCHALK, JONAS ANTON (RN)
Entity type:Individual
Prefix:
First Name:JONAS
Middle Name:ANTON
Last Name:GOSSCHALK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2013
Mailing Address - Country:US
Mailing Address - Phone:210-330-7805
Mailing Address - Fax:
Practice Address - Street 1:1700 N LOVERS LN
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-8013
Practice Address - Country:US
Practice Address - Phone:559-730-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95127437163WE0003X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WE0003XNursing Service ProvidersRegistered NurseEmergency