Healthcare Provider Details

I. General information

NPI: 1265865620
Provider Name (Legal Business Name): MARION GERTUDE GOODRICH ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HIGH ST SUITE 300
SPRINGFIELD MA
01105-1442
US

IV. Provider business mailing address

140 HIGH ST SUITE 300
SPRINGFIELD MA
01105-1442
US

V. Phone/Fax

Practice location:
  • Phone: 866-610-2273
  • Fax: 413-304-6365
Mailing address:
  • Phone: 866-610-2273
  • Fax: 413-304-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number115090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: