Provider Demographics
NPI:1578058764
Name:MINER-GOECKERITZ, NATALIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MINER-GOECKERITZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:ORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12190 S BOLBOA PARC LN APT A201
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6351
Mailing Address - Country:US
Mailing Address - Phone:435-340-8204
Mailing Address - Fax:
Practice Address - Street 1:389 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2310
Practice Address - Country:US
Practice Address - Phone:385-282-2700
Practice Address - Fax:385-282-2701
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8669658-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily