Individual
ANNETTE MICHELLE GOLUCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1512 N ZARAGOZA RD STE A1, EL PASO, TX 79936-8903
(915) 855-7700
Mailing address
122 W JOHN CARPENTER FWY STE 420, IRVING, TX 75039-2014
(972) 957-3000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP03554
NM
363LP0200X
Pediatric Nurse Practitioner
AP135944
TX
363LP0200X
Pediatric Nurse Practitioner
CNP-03554
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49451821
—
NM
01
—
659321YRND
MEDICARE
NM
Enumeration date
01/25/2018
Last updated
12/13/2021
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