Provider Demographics
NPI:1427790815
Name:GOETZ, DAYNA MARIE (RN)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:MARIE
Last Name:GOETZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1602
Mailing Address - Country:US
Mailing Address - Phone:920-655-7010
Mailing Address - Fax:
Practice Address - Street 1:1346 WESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1602
Practice Address - Country:US
Practice Address - Phone:920-655-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136396-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000Medicaid
WI000OtherINDEPENDENT HEALTH PROVIDER