Provider Demographics
NPI:1659683654
Name:GOEHRING, CANDIDA (C NP)
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:GOEHRING
Suffix:
Gender:F
Credentials:C NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656-0206
Mailing Address - Country:US
Mailing Address - Phone:605-865-3258
Mailing Address - Fax:605-845-8252
Practice Address - Street 1:1309 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-1146
Practice Address - Country:US
Practice Address - Phone:605-845-3692
Practice Address - Fax:605-845-8252
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1659683654Medicaid
S104312OtherPTAN