MEDICARE: CAROLE GOEBEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704113577	MI

General Provider Information

NPI Number	:	1043465354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE GOEBEL NP

Provider Business Mailing Address
First Line	:	255 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2218
Country	:	US
Telephone Number	:	800-853-8989
Fax Number	:	313-561-8837

Provider Business Practice Location Address
First Line	:	22255 GREENFIELD RD STE 500
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-3734
Country	:	US
Telephone Number	:	248-849-3192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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