Individual
CHANNA TERESE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
100 E FERGUSON ST STE 608, TYLER, TX 75702-5756
(903) 705-0070
Mailing address
100 E FERGUSON ST STE 608, TYLER, TX 75702-5756
(903) 705-0070
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
896590
TX
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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