Provider Demographics
NPI:1427802172
Name:GOFF, ETHEL M
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:M
Last Name:GOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:POWHATAN POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43942-1233
Mailing Address - Country:US
Mailing Address - Phone:740-228-5457
Mailing Address - Fax:
Practice Address - Street 1:119 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:POWHATAN POINT
Practice Address - State:OH
Practice Address - Zip Code:43942-1233
Practice Address - Country:US
Practice Address - Phone:740-228-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV18212061228Medicaid
WV125553494Medicaid
WV1356607394Medicaid