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Individual

CHAD BRIAN GOODERHAM

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
1060 GAFFNEY RD, FORT WAINWRIGHT, AK 99703-5001
(907) 353-5286
Mailing address
1123 SHANNON DR, FAIRBANKS, AK 99701-3811
(907) 457-5158

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1927-033
WI
363LF0000X
Family Nurse Practitioner
Primary
WI

Other

Enumeration date
11/30/2005
Last updated
09/11/2025
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