Provider Demographics
NPI:1821634981
Name:GOFF, REBEKAH LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:GOFF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:LYNN
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10800 MIDLOTHIAN TPKE STE 265
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4700
Mailing Address - Country:US
Mailing Address - Phone:804-594-1383
Mailing Address - Fax:804-594-0915
Practice Address - Street 1:10800 MIDLOTHIAN TPKE STE 265
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4700
Practice Address - Country:US
Practice Address - Phone:804-594-1383
Practice Address - Fax:804-594-0915
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001256615367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered