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Individual

JULIAN GOMBOSI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1100 GRAMPIAN BLVD, 4 SOUTH, WILLIAMSPORT, PA 17701-1909
(570) 320-7690
(570) 320-7692
Mailing address
1100 GRAMPIAN BLVD, 4 SOUTH, WILLIAMSPORT, PA 17701-1909
(570) 320-7690
(570) 320-7692

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
RN262305L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1015976760001
PA
Enumeration date
01/16/2014
Last updated
01/16/2014
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