Individual
SHANA GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1624 HILLCREST DR, MANITOWOC, WI 54220-1825
(920) 905-3568
Mailing address
1624 HILLCREST DR, MANITOWOC, WI 54220-1825
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
179390030
WI
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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