Basic Information
| Provider Information | |||||||||
| NPI: | 1215199500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOEMAN | ||||||||
| FirstName: | BOBBY | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053287180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3015 3RD AVE SE STE 104 | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574015539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057256700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | CP000531 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.