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General NPI Number Information
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NPI Number | 1578976619
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Entity Type | Organization
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Legal Business Name | GOEDHART MEDICAL GROUP
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 1320 E CALVADA BOULEVARD
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City | PAHRUMP
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State | NV
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Zip | 89048
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Country | US
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Telephone | 702-682-8155
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 E CALVADA BOULEVARD
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City | PAHRUMP
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State | NV
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Zip | 89048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RENAE GOEDHART
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Credential | APRN
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Telephone | 702-682-8155
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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 | APRN000597
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License Number State | NV
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