Provider Demographics
NPI:1063707727
Name:GOETZ, CHERYL ANN (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:GOETZ
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GOVE
Mailing Address - State:KS
Mailing Address - Zip Code:67736-0128
Mailing Address - Country:US
Mailing Address - Phone:785-938-2335
Mailing Address - Fax:785-938-2336
Practice Address - Street 1:520 WASHINGTON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:GOVE
Practice Address - State:KS
Practice Address - Zip Code:67736-0128
Practice Address - Country:US
Practice Address - Phone:785-938-2335
Practice Address - Fax:785-938-2336
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS13-62595051163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS486010423OtherTRI-CARE