Healthcare Provider Details

I. General information

NPI: 1366658049
Provider Name (Legal Business Name): ANNETTE HARRIET GOODMAN APRN BE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 US ROUTE ONE
FALMOUTH ME
04105-1350
US

IV. Provider business mailing address

367 US ROUTE ONE
FALMOUTH ME
04105-1350
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-7701
  • Fax: 207-781-7704
Mailing address:
  • Phone: 207-781-7701
  • Fax: 207-781-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR017858
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: