Provider Demographics
NPI:1912259854
Name:GOOCH, DENESE MICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DENESE
Middle Name:MICHELLE
Last Name:GOOCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DENESE
Other - Middle Name:
Other - Last Name:TOOMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:623 CHESHIER ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1101
Mailing Address - Country:US
Mailing Address - Phone:731-836-0052
Mailing Address - Fax:
Practice Address - Street 1:623 CHESHIER ST
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1101
Practice Address - Country:US
Practice Address - Phone:731-836-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000065629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse