Healthcare Provider Details

I. General information

NPI: 1487760369
Provider Name (Legal Business Name): PETRA GOODMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG, ATTN: PRIMARY CARE CLINIC CMR 446, UNIT 26610
WUERZBURG BAVARIA
APO AE 09244
DE

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE CMR 446, UNIT 26610
WUERZBURG BAVARIA
APO AE 09244
DE

V. Phone/Fax

Practice location:
  • Phone: 011499318043966
  • Fax:
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberWH 1574
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: