Healthcare Provider Details

I. General information

NPI: 1205261815
Provider Name (Legal Business Name): HEATHER GOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 13TH ST
PARKERSBURG WV
26101-4144
US

IV. Provider business mailing address

1210 13TH ST
PARKERSBURG WV
26101-4144
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-6513
  • Fax:
Mailing address:
  • Phone: 304-485-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79033
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: