Provider Demographics
NPI:1518565720
Name:GOFF, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0892
Mailing Address - Country:US
Mailing Address - Phone:681-334-5127
Mailing Address - Fax:
Practice Address - Street 1:130 ROW HOLLOW RD.
Practice Address - Street 2:
Practice Address - City:KOPPERSTON
Practice Address - State:WV
Practice Address - Zip Code:24854
Practice Address - Country:US
Practice Address - Phone:681-334-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant