Provider Demographics
NPI:1588318182
Name:GOETHEL, EMMA ANN (PA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ANN
Last Name:GOETHEL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9820 BROOKEMOOR PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-7332
Mailing Address - Country:US
Mailing Address - Phone:804-754-5048
Mailing Address - Fax:
Practice Address - Street 1:6379 CENTER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4102
Practice Address - Country:US
Practice Address - Phone:757-467-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant