Provider Demographics
NPI:1639476153
Name:GOERKE, EMILY KATHRYN (CRNA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:GOERKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 SW MILES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:6400 SE LAKE ROAD, SUITE 130
Practice Address - Street 2:ANESTHESIA ASSOCIATES NORTHWEST
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-594-1774
Practice Address - Fax:503-594-1775
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 184004-9367500000X
OR201160047CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN430007427Medicare PIN