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Individual
STANLEY GOODING
Active
Individual
STANLEY GOODING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
131063
MO
363L00000X
Nurse Practitioner
2017001791
MO
363LF0000X
Family Nurse Practitioner
2017001791
MO
363LF0000X
Family Nurse Practitioner
Primary
209015670
IL
Other
Enumeration date
01/18/2017
Last updated
04/05/2017
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