Provider Demographics
NPI:1609346501
Name:GOULD, MARY ELIZABETH (RN BSN PHN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GOULD
Suffix:
Gender:F
Credentials:RN BSN PHN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:REIMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN PHN
Mailing Address - Street 1:12780 BIG BEND WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6450
Mailing Address - Country:US
Mailing Address - Phone:760-505-0420
Mailing Address - Fax:
Practice Address - Street 1:1234 ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3404
Practice Address - Country:US
Practice Address - Phone:760-310-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369948163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool