Provider Demographics
NPI:1255365631
Name:GOSHORN, CINDY R (DNP ARNP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:DNP ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 50TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5940
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:888-503-7693
Practice Address - Street 1:935 W 18TH ST S
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3500
Practice Address - Country:US
Practice Address - Phone:641-871-0764
Practice Address - Fax:641-792-2745
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA096742363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1477857704OtherWELLMARK BCBS
IA007458OtherWELLMARK/BLUE CROSS
IA1477857704Medicaid
IA0074583Medicaid
IAP01035746OtherRR MEDICARE
IA700060017Medicare PIN
IAI-20300Medicare PIN
IAIB2056001Medicare PIN
IA007458OtherWELLMARK/BLUE CROSS
IAP01035746OtherRR MEDICARE
IA058230006Medicare PIN