Individual
MARILYN D GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
848 PIERSON AVE., NEWARK, NY 14513
(315) 331-2086
Mailing address
762 TOWNLINE RD, LYONS, NY 14489-9619
(315) 331-2086
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
284222-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043414170
ROOSEVELT CHILDREN'S CENTER
NY
01
—
23-7540582
ROOSEVELT CHILDREN'S CENTER
NY
Enumeration date
12/03/2008
Last updated
12/03/2008
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