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NPI Code Detail

MEDICARE: MAKENZIE MARIE GOODELL RN

MEDICARE: MAKENZIE MARIE GOODELL RN
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
1163W00000XRegistered Nurse162976IA

General Provider Information

NPI Number : 1902760515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE MARIE GOODELL RN
Provider Business Mailing Address
First Line : 2213 OSPREY LN
Second Line :
City : MC LEANSVILLE
State : NC
Zip : 27301-3007
Country : US
Telephone Number : 515-851-0799
Fax Number :
Provider Business Practice Location Address
First Line : 1100 E WENDOVER AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-6713
Country : US
Telephone Number : 336-641-3176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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