Healthcare Provider Details

I. General information

NPI: 1174747794
Provider Name (Legal Business Name): SANDRA GOULET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7031
US

IV. Provider business mailing address

1302 ROMANCOKE RD
STEVENSVILLE MD
21666-2818
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-7381
  • Fax:
Mailing address:
  • Phone: 443-249-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberR066478
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: