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NPI Code Detail

MEDICARE: DEBRA JO GOODALL NP-C

MEDICARE: DEBRA JO GOODALL NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner4704220755MI
2363L00000XNurse Practitioner4704220755MI

General Provider Information

NPI Number : 1659553782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA JO GOODALL NP-C
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 INVESTMENT DR STE 200
Second Line :
City : TROY
State : MI
Zip : 48098-6375
Country : US
Telephone Number : 248-267-5050
Fax Number : 248-267-5051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2007
Last Update Date : 02/16/2026

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Directions to “ DEBRA JO GOODALL NP-C” Practice Location

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