Basic Information
| Provider Information | |||||||||
| NPI: | 1487857629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUGE | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BLOOD | ||||||||
| OtherFirstName: | FAITH | ||||||||
| OtherMiddleName: | E. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2 READS WAY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094709 | ||||||||
| FaxNumber: | 3027094551 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON ROAD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197181320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027331000 | ||||||||
| FaxNumber: | 3027332685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | L10029071 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | LJ0000238 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | L6-0A00690 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0133612 | 05 | NJ | MEDICAID | H13391900 | 05 | MD | MEDICAID |