Provider Demographics
NPI:1154933729
Name:GOEBEL, MARISKA CORNELIA (DNP, APNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARISKA
Middle Name:CORNELIA
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-C
Other - Prefix:
Other - First Name:MARISKA
Other - Middle Name:
Other - Last Name:VANDENBERGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6220 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2448
Mailing Address - Country:US
Mailing Address - Phone:414-423-0555
Mailing Address - Fax:
Practice Address - Street 1:6220 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2448
Practice Address - Country:US
Practice Address - Phone:414-423-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021755363LF0000X
WI10291-33363LF0000X, 363L00000X
FLAPRN11008277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily