Individual
LISA F GOEDERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
410 DARLING AVE, WAYCROSS, GA 31501-5246
(912) 338-6511
(336) 553-3994
Mailing address
PO BOX 18824, GREENSBORO, NC 27419-8824
(336) 553-1659
(336) 553-3994
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN131307
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00352168
RR MEDICARE
GA
Enumeration date
03/02/2006
Last updated
11/28/2007
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