Healthcare Provider Details

I. General information

NPI: 1841039625
Provider Name (Legal Business Name): MONIQUE LASHAE GOODMAN DNP,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SUMMIT CROSSING PL STE 108A
GASTONIA NC
28054-2189
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-2229
  • Fax: 704-865-2811
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number981
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: