Provider Demographics
NPI:1093303679
Name:GOFF, JANE R (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:GOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9550
Mailing Address - Country:US
Mailing Address - Phone:601-750-1513
Mailing Address - Fax:
Practice Address - Street 1:545 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9550
Practice Address - Country:US
Practice Address - Phone:601-750-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS576786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse