Provider Demographics
NPI:1750939500
Name:GOENS, MARY TERESA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:GOENS
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 1:801 STEVIES TRL
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8363
Mailing Address - Country:US
Mailing Address - Phone:859-363-3186
Mailing Address - Fax:
Practice Address - Street 1:801 STEVIES TRL
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8363
Practice Address - Country:US
Practice Address - Phone:859-363-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider