Provider Demographics
NPI:1407173743
Name:GOODSHIELD OCEGUERA, PATRICIA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:GOODSHIELD OCEGUERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:GOODSHIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:207 PRAIRIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROSHOLT
Mailing Address - State:SD
Mailing Address - Zip Code:57260-2253
Mailing Address - Country:US
Mailing Address - Phone:605-537-4304
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE TRAVERSE DR.
Practice Address - Street 2:
Practice Address - City:SISSETON,
Practice Address - State:SD
Practice Address - Zip Code:57262-7046
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN05904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse