Provider Demographics
NPI:1447569793
Name:GOEKE, RHONDA JO (LPN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JO
Last Name:GOEKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1146
Mailing Address - Country:US
Mailing Address - Phone:585-658-9503
Mailing Address - Fax:
Practice Address - Street 1:35 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1009
Practice Address - Country:US
Practice Address - Phone:585-658-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301886164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse