Provider Demographics
NPI:1285689307
Name:GOSS, SHARI LYNN (PNP)
Entity type:Individual
Prefix:MS
First Name:SHARI
Middle Name:LYNN
Last Name:GOSS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:LYNN
Other - Last Name:KUPAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:9118 BUTTERNUT ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5601
Mailing Address - Country:US
Mailing Address - Phone:612-741-8978
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0960030363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP16335Medicare UPIN