Healthcare Provider Details

I. General information

NPI: 1285686584
Provider Name (Legal Business Name): JOANNA C GOLDMAN ANP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

IV. Provider business mailing address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-1812
  • Fax: 907-789-7168
Mailing address:
  • Phone: 907-789-1812
  • Fax: 907-789-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number39110009
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number39110009
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: