Provider Demographics
NPI:1265429690
Name:GOETZMAN, BETH A (APNP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:GOETZMAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ARLENE
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1866
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2820 ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3834
Practice Address - Country:US
Practice Address - Phone:715-735-5225
Practice Address - Fax:715-735-5388
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI382033363L00000X
WI382-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4825080008OtherMEDICARE DME
WI43824100Medicaid
WI4825080008OtherMEDICARE DME
R81260Medicare UPIN
WI43824100Medicaid
WI500018070Medicare Oscar/Certification
WI4825080008Medicare Oscar/Certification