Healthcare Provider Details

I. General information

NPI: 1609965870
Provider Name (Legal Business Name): KATHY GOFF L.P.N., SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW PETTYGROVE ST SUITE 210
PORTLAND OR
97210-2659
US

IV. Provider business mailing address

9546 N CLARENDON AVE
PORTLAND OR
97203-1914
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-6223
  • Fax: 503-223-3665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: