Healthcare Provider Details

I. General information

NPI: 1295230605
Provider Name (Legal Business Name): SARA ELIZABETH ARRIERO GOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA ELIZABETH ARRIERO GOFF FNP

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 S MAIN ST
MYRTLE CREEK OR
97457
US

IV. Provider business mailing address

PO BOX 1534
MYRTLE CREEK OR
97457-0139
US

V. Phone/Fax

Practice location:
  • Phone: 208-830-7810
  • Fax:
Mailing address:
  • Phone: 208-830-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF95008792
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNPF95008792
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerCASE MANAGER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: