Provider Demographics
NPI:1154940708
Name:GAYDOSH, ELIZABETH CLARE (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARE
Last Name:GAYDOSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 AUTUMN RUN DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8821
Mailing Address - Country:US
Mailing Address - Phone:330-591-1559
Mailing Address - Fax:
Practice Address - Street 1:4680 AUTUMN RUN DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8821
Practice Address - Country:US
Practice Address - Phone:330-591-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG07190196363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology