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General NPI Number Information
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NPI Number | 1871091876
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Entity Type | Individual
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Provider Name | ANNETTE MICHELLE GOLUCKE CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 1512 N ZARAGOZA RD STE A1
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City | EL PASO
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State | TX
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Zip | 79936-8903
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Country | US
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Telephone | 915-855-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 122 W JOHN CARPENTER FWY STE 420
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City | IRVING
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State | TX
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Zip | 75039-2014
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Country | US
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Telephone | 972-957-3000
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP135944
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP-03554
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License Number State | NM
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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 | CNP03554
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License Number State | NM
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