Provider Demographics
NPI:1700647872
Name:GOEDJEN, JESSICA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:GOEDJEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1396 CANOOCHEE DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3432
Mailing Address - Country:US
Mailing Address - Phone:313-598-2272
Mailing Address - Fax:
Practice Address - Street 1:1396 CANOOCHEE DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3432
Practice Address - Country:US
Practice Address - Phone:313-598-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse