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General NPI Number Information
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NPI Number | 1275585382
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Entity Type | Individual
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Provider Name | RENAE SUE GOEDHART APRN
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 3370 S HIGHWAY 160 STE 9
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City | PAHRUMP
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State | NV
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Zip | 89048-5373
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Country | US
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Telephone | 775-513-5038
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Fax | 775-376-9966
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | PAHRUMP
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State | NV
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Zip | 89041-1089
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Country | US
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Telephone | 775-513-5038
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Fax | 775-376-9966
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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 | APN000597
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License Number State | NV
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