Provider Demographics
NPI:1679387054
Name:GOITOM, SENAYET (DNP)
Entity type:Individual
Prefix:DR
First Name:SENAYET
Middle Name:
Last Name:GOITOM
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 DAVENPORT ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4229
Mailing Address - Country:US
Mailing Address - Phone:612-499-2098
Mailing Address - Fax:
Practice Address - Street 1:464 2ND ST STE 204
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2015
Practice Address - Country:US
Practice Address - Phone:612-787-8408
Practice Address - Fax:612-567-8935
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12484208VP0000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily