Individual
JACQUELINE A GOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
2741 ROOSEVELT RD, MARINETTE, WI 54143-3833
(715) 732-1392
Mailing address
3120 RIVERSIDE AVE, GATE B BUILDING 1, MARINETTE, WI 54143-1123
(715) 732-2078
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5222-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704302472
MICHIGAN LICENSE
MI
Enumeration date
02/04/2013
Last updated
03/19/2014
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