Provider Demographics
NPI:1538744230
Name:GOEHNER, MICA RAE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MICA
Middle Name:RAE
Last Name:GOEHNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31038 COUNTRY GDNS STE D2
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-5410
Mailing Address - Country:US
Mailing Address - Phone:302-589-0019
Mailing Address - Fax:800-349-1807
Practice Address - Street 1:31038 COUNTRY GDNS STE D2
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-5410
Practice Address - Country:US
Practice Address - Phone:025-890-0193
Practice Address - Fax:800-349-1807
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG-001594OtherDE FNP LICENSE