Provider Demographics
NPI:1538260856
Name:GOETZ, MARTHA JEAN (FNP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEAN
Last Name:GOETZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2621
Mailing Address - Country:US
Mailing Address - Phone:231-261-1843
Mailing Address - Fax:949-695-2102
Practice Address - Street 1:413 HOWARD ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2621
Practice Address - Country:US
Practice Address - Phone:231-261-1843
Practice Address - Fax:949-695-2102
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY263300970363LF0000X
MI4704214400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4945654Medicaid
MICB0014OtherRAILROAD MEDICARE
MICB0014OtherRAILROAD MEDICARE
MI4945654Medicaid
MI0P09580Medicare PIN