Healthcare Provider Details

I. General information

NPI: 1194816116
Provider Name (Legal Business Name): LISA GOFF PAGEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RENE GOFF CRNA

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CRAIG RD
EAU CLAIRE WI
54701-6118
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-4610
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3003751
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209019984
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7467
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: