1427377498 NPI number — TERRA DEANN GOANS RN, BSN, BS, AS

Table of content: TERRA DEANN GOANS RN, BSN, BS, AS (NPI 1427377498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427377498 NPI number — TERRA DEANN GOANS RN, BSN, BS, AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOANS
Provider First Name:
TERRA
Provider Middle Name:
DEANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, BS, AS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEAVENGOOD
Provider Other First Name:
TERRA
Provider Other Middle Name:
DEANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427377498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 W MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73701-4027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-234-8865
Provider Business Mailing Address Fax Number:
580-234-8361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 W MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-234-8865
Provider Business Practice Location Address Fax Number:
580-234-8361
Provider Enumeration Date:
05/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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