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General NPI Number Information
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NPI Number | 1679387054
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Entity Type | Individual
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Provider Name | SENAYET GOITOM DNP
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Gender | Female
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 04/27/2025
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Provider Practice Location Address
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Address Line | 464 2ND ST STE 204
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City | EXCELSIOR
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State | MN
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Zip | 55331-2015
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Country | US
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Telephone | 612-787-8408
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Fax | 612-567-8935
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Provider Business Mailing Address
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Address Line | 8745 DAVENPORT ST NE
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City | BLAINE
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State | MN
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Zip | 55449-4229
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Country | US
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Telephone | 612-499-2098
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Fax |
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 12484
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12484
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12484
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License Number State | MN
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