Provider Demographics
NPI:1336669712
Name:GOYAL, JAIMIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:MARIE
Last Name:GOYAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 31ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2454
Mailing Address - Country:US
Mailing Address - Phone:612-481-3548
Mailing Address - Fax:
Practice Address - Street 1:2650 RICE ST
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55113-2201
Practice Address - Country:US
Practice Address - Phone:651-484-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily