Provider Demographics
NPI:1437962917
Name:GOTHARD, PAUL (ARNP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GOTHARD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5106
Mailing Address - Country:US
Mailing Address - Phone:563-582-1220
Mailing Address - Fax:563-582-8089
Practice Address - Street 1:1670 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5106
Practice Address - Country:US
Practice Address - Phone:563-582-1220
Practice Address - Fax:563-582-8089
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA183037363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner