Individual
REBECCA J GOODSPEED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3025 W CHERRY LN, SUITE B, MERIDIAN, ID 83642-8531
(208) 302-6450
(208) 302-6455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-6450
(208) 302-6455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA524
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807176000
—
ID
Enumeration date
06/20/2006
Last updated
11/15/2016
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