Provider Demographics
NPI:1548780224
Name:GOETTEMOELLER, DEBORAH JO (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JO
Last Name:GOETTEMOELLER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 BURKETTSVILLE SAINT HEN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9696
Mailing Address - Country:US
Mailing Address - Phone:419-678-8658
Mailing Address - Fax:
Practice Address - Street 1:2226 BURKETTSVILLE SAINT HEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-9696
Practice Address - Country:US
Practice Address - Phone:419-678-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.306348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse