Individual
AUDREYONNA GOODISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 WOODLAWN AVE W, UTICA, NY 13502-6010
(315) 601-7652
Mailing address
103 WOODLAWN AVE W, UTICA, NY 13502-6010
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304362
NY
Other
Enumeration date
02/09/2014
Last updated
02/09/2014
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