Provider Demographics
NPI:1114926243
Name:GOBEN, CHARITY J (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:J
Last Name:GOBEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:JADE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2473
Mailing Address - Country:US
Mailing Address - Phone:507-434-6982
Mailing Address - Fax:507-434-6983
Practice Address - Street 1:1906 8TH ST NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2473
Practice Address - Country:US
Practice Address - Phone:507-434-6982
Practice Address - Fax:507-434-6982
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14489363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00827942OtherRAILROAD MEDICARE
OK200188040AMedicaid
S48271Medicare UPIN
OKOK404766Medicare PIN