Provider Demographics
NPI:1467702589
Name:GOEDEKE, JANIS C (APRN)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:C
Last Name:GOEDEKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E ATKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2342
Mailing Address - Country:US
Mailing Address - Phone:620-235-7114
Mailing Address - Fax:620-235-7115
Practice Address - Street 1:410 E ATKINSON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2342
Practice Address - Country:US
Practice Address - Phone:620-235-7114
Practice Address - Fax:620-235-7115
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44220163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory