Individual
WENDY MONIQUE GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
623 S MAIN ST STE 1, MOSCOW, ID 83843-2983
(208) 882-2011
(208) 883-1853
Mailing address
623 S MAIN ST STE 1, MOSCOW, ID 83843-3042
(208) 882-2011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PA030391
DC
363A00000X
Physician Assistant
5747
GA
363A00000X
Physician Assistant
Primary
PA-1297
ID
Other
Enumeration date
11/06/2006
Last updated
07/19/2024
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