Provider Demographics
NPI:1316217946
Name:GOESCH, TARA LEAH (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEAH
Last Name:GOESCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEAH
Other - Last Name:TEPLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:14080 HOSPITAL RD
Practice Address - Street 2:CHILDREN'S HOSP & MEDICAL CTR - CARDIOTHORACIC SURGERY
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7513
Practice Address - Country:US
Practice Address - Phone:402-778-6900
Practice Address - Fax:402-778-6917
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111280363LP0200X
NE111185363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics