Provider Demographics
NPI:1740512243
Name:GOFFNEY, JARLEAN
Entity type:Individual
Prefix:MS
First Name:JARLEAN
Middle Name:
Last Name:GOFFNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6728
Mailing Address - Country:US
Mailing Address - Phone:602-243-3405
Mailing Address - Fax:
Practice Address - Street 1:1415 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6728
Practice Address - Country:US
Practice Address - Phone:602-243-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant