Provider Demographics
NPI:1336323153
Name:GOEKEN, CAROL ANN (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:GOEKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:GUASPARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1209 WOODROW AVE STE B10
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1273
Mailing Address - Country:US
Mailing Address - Phone:209-558-5312
Mailing Address - Fax:209-558-5310
Practice Address - Street 1:1209 WOODROW AVE STE B10
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1273
Practice Address - Country:US
Practice Address - Phone:209-558-5312
Practice Address - Fax:209-558-5310
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner