Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R024702 | ME |
NPI | 1013020734 |
---|---|
Provider Name | Ms. Launa M Gonsioroski |
First Address | Mapleton, ME 04757 |
Second Address | Caribou, ME 04736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |