Healthcare Provider Details

I. General information

NPI: 1215329008
Provider Name (Legal Business Name): NICOLE GOEMANN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BARNES ST
OCEANSIDE CA
92054-3406
US

IV. Provider business mailing address

104 BARNES ST
OCEANSIDE CA
92054-3406
US

V. Phone/Fax

Practice location:
  • Phone: 760-967-4401
  • Fax:
Mailing address:
  • Phone: 760-967-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number835784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: