Provider Demographics
NPI:1518021278
Name:GOFF, PHYLLIS ARLYNE
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ARLYNE
Last Name:GOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:MARTIN
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:175 WEST SUNDANCE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382
Mailing Address - Country:US
Mailing Address - Phone:281-465-4376
Mailing Address - Fax:
Practice Address - Street 1:3115 COLLEGE PARK DRIVE
Practice Address - Street 2:STE 104
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-321-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189870164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse