Provider Demographics
NPI:1962093948
Name:GOERDT, JESSIE RENEE (CNA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:RENEE
Last Name:GOERDT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 CIMARRON WAY APT 35
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2782
Mailing Address - Country:US
Mailing Address - Phone:775-385-6857
Mailing Address - Fax:
Practice Address - Street 1:1515 7TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2859
Practice Address - Country:US
Practice Address - Phone:775-753-7110
Practice Address - Fax:775-753-3551
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker