Provider Demographics
NPI:1427377498
Name:GOANS, TERRA DEANN (RN, BSN, BS, AS)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:DEANN
Last Name:GOANS
Suffix:
Gender:F
Credentials:RN, BSN, BS, AS
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:DEANN
Other - Last Name:LEAVENGOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:121 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4027
Mailing Address - Country:US
Mailing Address - Phone:580-234-8865
Mailing Address - Fax:580-234-8361
Practice Address - Street 1:121 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4027
Practice Address - Country:US
Practice Address - Phone:580-234-8865
Practice Address - Fax:580-234-8361
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation