Healthcare Provider Details

I. General information

NPI: 1356337208
Provider Name (Legal Business Name): DEBORAH CARROLL GOOTEE PSYCHIATRIC NURSE PR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29516 CANVASBACK DR
EASTON MD
21601-7140
US

IV. Provider business mailing address

2336 GODDARD PKWY
SALISBURY MD
21801-1126
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-5007
  • Fax: 410-822-5569
Mailing address:
  • Phone: 410-334-6961
  • Fax: 410-334-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR053273
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR053273
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: