Provider Demographics
NPI:1346229374
Name:GOE, CINDY J (CRNA MA)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:J
Last Name:GOE
Suffix:
Gender:F
Credentials:CRNA MA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:J
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA RN
Mailing Address - Street 1:14619 S LUCILLE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8108
Mailing Address - Country:US
Mailing Address - Phone:913-681-9716
Mailing Address - Fax:
Practice Address - Street 1:14619 S LUCILLE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8108
Practice Address - Country:US
Practice Address - Phone:913-681-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086588367500000X
KS14 56228 071367500000X
KS54230367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R30498Medicare UPIN
KS4065032BMedicare ID - Type Unspecified
MO4065032Medicare ID - Type Unspecified