Provider Demographics
NPI:1780092304
Name:GOLA, SOWSINA BERHE
Entity type:Individual
Prefix:
First Name:SOWSINA
Middle Name:BERHE
Last Name:GOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ELM ST STE 4210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7282
Mailing Address - Country:US
Mailing Address - Phone:430-803-0511
Mailing Address - Fax:
Practice Address - Street 1:2312 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4915
Practice Address - Country:US
Practice Address - Phone:430-803-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180855363LF0000X
NC247243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse