Individual
HEATHER GOSNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4137 N 108TH AVE, PHOENIX, AZ 85037-5459
(623) 877-7337
Mailing address
4137 N 108TH AVE, PHOENIX, AZ 85037-5459
(623) 877-7337
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
40887
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
378517
—
AZ
Enumeration date
08/30/2005
Last updated
06/29/2021
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