Healthcare Provider Details

I. General information

NPI: 1235534900
Provider Name (Legal Business Name): CHERYL LYNN GOODLOW FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 RTE 33 BOOKER PAVILION 1ST FLOOR
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1945 RTE 33 BOOKER PAVILION 1ST FLOOR
NEPTUNE NJ
07753-4859
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4578
  • Fax: 732-776-4641
Mailing address:
  • Phone: 732-776-4578
  • Fax: 732-776-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00527900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: