Provider Demographics
NPI:1942513429
Name:GOSTOMSKI, CYNTHIA G (MSN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:G
Last Name:GOSTOMSKI
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14806 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3700
Mailing Address - Country:US
Mailing Address - Phone:313-929-1248
Mailing Address - Fax:
Practice Address - Street 1:2850 S INDUSTRIAL HWY
Practice Address - Street 2:SUITE 75
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6796
Practice Address - Country:US
Practice Address - Phone:734-477-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1708582163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health