Healthcare Provider Details

I. General information

NPI: 1972831584
Provider Name (Legal Business Name): CORINNE ELIZABETH GOFF RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD # D-302
N KINGSTOWN RI
02852-4161
US

IV. Provider business mailing address

53 COUNTRY CT
N KINGSTOWN RI
02852-2901
US

V. Phone/Fax

Practice location:
  • Phone: 401-286-3373
  • Fax:
Mailing address:
  • Phone: 401-286-3373
  • Fax: 401-349-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0658
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: