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General NPI Number Information
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NPI Number | 1194711911
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Entity Type | Individual
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Provider Name | KATHLEEN M GOFF NP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 4900 BROAD RD CGH POB SUITE 2V
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-492-5005
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Fax | 315-492-5324
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Provider Business Mailing Address
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Address Line | PO BOX 2003
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4503
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Country | US
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Telephone | 315-446-3904
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Fax | 315-445-2936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F330961
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License Number State | NY
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