1255365631 NPI number — CINDY R GOSHORN DNP ARNP

Table of content: CINDY R GOSHORN DNP ARNP (NPI 1255365631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255365631 NPI number — CINDY R GOSHORN DNP ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSHORN
Provider First Name:
CINDY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255365631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 50TH ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-5940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-237-3974
Provider Business Mailing Address Fax Number:
888-503-7693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 W 18TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50208-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-871-0764
Provider Business Practice Location Address Fax Number:
641-792-2745
Provider Enumeration Date:
07/10/2006

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: 363LP0808X , with the licence number:  A096742 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477857704 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 007458 . This is a "WELLMARK/BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477857704 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0074583 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01035746 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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