Individual
NISSA J GOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1611 POND RD, SUITE 401, ALLENTOWN, PA 18104-2258
(610) 398-7700
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
MW010224
PA
Other
Enumeration date
09/30/2010
Last updated
12/18/2015
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