Individual
MS. HALEY DAWN GOSVENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1234 EMPIRE ST STE 2200, FAIRFIELD, CA 94533-5711
(707) 648-8121
Mailing address
5013 PEABODY RD # A, FAIRFIELD, CA 94533-8907
(707) 208-4604
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
692481
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164X00000X
—
CA
Enumeration date
04/23/2018
Last updated
04/23/2018
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