Individual
MRS. ANDREA MARIE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAS, PA-C
Contact information
Practice address
MSC06 3870 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131
(505) 277-3136
Mailing address
19 HOLIDAY LOOP, TIJERAS, NM 87059-7896
(618) 697-2082
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085004195
IL
363A00000X
Physician Assistant
Primary
PA2017-0087
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750550067
UNIVERSITY OF NEW MEXICO STUDENT HEALTH AND COUNSELING
NM
Enumeration date
10/20/2011
Last updated
01/10/2019
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