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NPI Code Detail

MEDICARE: MARTHENIA GOODSON LPN

MEDICARE: MARTHENIA GOODSON LPN
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
1164W00000XLicensed Practical Nurse314597NY

General Provider Information

NPI Number : 1851730105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHENIA GOODSON LPN
Provider Business Mailing Address
First Line : 504 SAWYER ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14619-1714
Country : US
Telephone Number : 585-228-0647
Fax Number :
Provider Business Practice Location Address
First Line : 504 SAWYER ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14619-1714
Country : US
Telephone Number : 585-228-0647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2013
Last Update Date : 06/20/2013

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