Individual
BENJAMIN ASHBY GOODRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNM, FNP
Contact information
Practice address
2450 ASHBY AVE, BERKELEY, CA 94705-2067
(510) 204-3977
Mailing address
PO BOX 276950, SACRAMENTO, CA 95827-6950
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
CNM236316
CA
363LF0000X
Family Nurse Practitioner
201406326NP-PP
OR
367A00000X
Advanced Practice Midwife
F002184-01
NY
Other
Enumeration date
09/12/2014
Last updated
05/06/2025
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