Provider Demographics
NPI:1740449685
Name:GOETZ, MARY ANN (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:GOETZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:3814 JAMES CT
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0965
Practice Address - Country:US
Practice Address - Phone:740-454-7119
Practice Address - Fax:740-455-5155
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN181892163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse