Provider Demographics
NPI:1487857629
Name:GOUGE, FAITH E (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:E
Last Name:GOUGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:E
Other - Last Name:BLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-1320
Practice Address - Country:US
Practice Address - Phone:302-733-1000
Practice Address - Fax:302-733-2685
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10029071363L00000X
DELJ0000238363L00000X
DEL6-0A00690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0133612Medicaid
MDH13391900Medicaid
NJ0133612Medicaid