Provider Demographics
NPI:1710067327
Name:GOEDERT, MARTHA HOFFMAN (CNM FNP, PHD,FACNM)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:HOFFMAN
Last Name:GOEDERT
Suffix:
Gender:F
Credentials:CNM FNP, PHD,FACNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6288 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-1854
Mailing Address - Country:US
Mailing Address - Phone:402-990-5250
Mailing Address - Fax:
Practice Address - Street 1:6288 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-1854
Practice Address - Country:US
Practice Address - Phone:402-990-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51363163W00000X
NE110117363LF0000X
NE120006367A00000X
WAAP60031352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA470765154OtherFEDERAL ID NUMBER
IA0420166Medicaid
IA470765154OtherFEDERAL ID NUMBER