Individual
JENA ELIZABETH GOULD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1205 PROVIDENT DRIVE, SUITE A, WARSAW, IN 46580-3265
(574) 269-8383
(574) 269-8384
Mailing address
PO BOX 996, WARSAW, IN 46581-0996
(574) 269-8383
(574) 269-8384
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003002A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002210
—
IN
Enumeration date
08/25/2009
Last updated
04/25/2012
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