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Individual

MAGGIE GOODMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
555 E BROADWAY AVE STE 216, JACKSON, WY 83001-8640
(724) 679-5642
Mailing address
PO BOX 3544, JACKSON, WY 83001-3544
(724) 679-5642

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA951
WY
363A00000X
Physician Assistant
PT951
WY

Other

Enumeration date
06/08/2021
Last updated
11/09/2021
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