Provider Demographics
NPI:1376038968
Name:GOFF, SUZETTE MARIE (DNP)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:MARIE
Last Name:GOFF
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 LARCH PL
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3915
Mailing Address - Country:US
Mailing Address - Phone:734-915-8141
Mailing Address - Fax:
Practice Address - Street 1:7804 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1702
Practice Address - Country:US
Practice Address - Phone:313-388-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily