Individual
DIANE M GOODMAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP APRN
Contact information
Practice address
1445 N HUNT CLUB ROAD, SUITE 102, GURNEE, IL 60031
(847) 855-2493
(847) 855-2490
Mailing address
9217 73RD ST, KENOSHA, WI 53142
(262) 942-7250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
IL
Other
Enumeration date
04/21/2006
Last updated
07/08/2007
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