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Individual
CAROL GOODREAU
Active
Individual
CAROL GOODREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
170046
WI
163WP0808X
Psychiatric/Mental Health Registered Nurse
4704222349
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170046
WI RN LICENSE
WI
01
—
4704222349
MI REGISTERED NURSE LICENSE NUMBER
MI
Enumeration date
07/25/2013
Last updated
04/08/2015
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