Healthcare Provider Details

I. General information

NPI: 1366414856
Provider Name (Legal Business Name): DAISY J GOODMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC - OB/GYN
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC - OB/GYN
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9303
  • Fax: 603-650-0902
Mailing address:
  • Phone: 603-653-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR045622
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number045622
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number045116-23
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number045116-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: