Individual
CHRISTINA GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 STUDENT HEALTH CENTER BUILDING, REXBURG, ID 83440
(208) 496-1300
(208) 496-1306
Mailing address
490 PIONEER RD APT 1204, REXBURG, ID 83440-3799
(208) 351-6470
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA591
ID
Other
Enumeration date
08/03/2006
Last updated
07/08/2007
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