Provider Demographics
NPI:1548384860
Name:GOLDMAN, JO ANNE (RT RCIS CCRC)
Entity Type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:RT RCIS CCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 60
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-3793
Mailing Address - Fax:612-863-6515
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 60
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-3793
Practice Address - Fax:612-863-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17696246XC2901X
MN127505247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist