Provider Demographics
NPI:1194472712
Name:GOEMBEL, TRISHA (CNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:GOEMBEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 NE PARK ST
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1230
Mailing Address - Country:US
Mailing Address - Phone:507-227-4005
Mailing Address - Fax:
Practice Address - Street 1:517 NE PARK ST
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1230
Practice Address - Country:US
Practice Address - Phone:507-227-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty