Provider Demographics
NPI:1316170178
Name:GOSSMAN, CARRAYN NICCOLE (NP)
Entity type:Individual
Prefix:MS
First Name:CARRAYN
Middle Name:NICCOLE
Last Name:GOSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9708
Mailing Address - Country:US
Mailing Address - Phone:319-232-5696
Mailing Address - Fax:
Practice Address - Street 1:2515 CYCLONE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9746
Practice Address - Country:US
Practice Address - Phone:319-233-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-095218363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner