Provider Demographics
NPI:1619351624
Name:GOETZ, COLLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GOETZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 MEREDITH CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1406
Mailing Address - Country:US
Mailing Address - Phone:603-393-4497
Mailing Address - Fax:
Practice Address - Street 1:39 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4222
Practice Address - Country:US
Practice Address - Phone:603-393-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203794363LA2100X
NH087380-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care