Provider Demographics
NPI:1649575580
Name:GOETHE, LAURA LEE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:GOETHE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2778
Mailing Address - Country:US
Mailing Address - Phone:520-459-0362
Mailing Address - Fax:520-458-1585
Practice Address - Street 1:1620 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2778
Practice Address - Country:US
Practice Address - Phone:520-459-0362
Practice Address - Fax:520-458-1585
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily