Healthcare Provider Details

I. General information

NPI: 1093899478
Provider Name (Legal Business Name): MICHELLE S GOODMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE S STARK

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 HIGHWAY 99 STE 260
EDMONDS WA
98026-8049
US

IV. Provider business mailing address

PO BOX 34888
SEATTLE WA
98124-1888
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-2650
  • Fax: 425-774-2643
Mailing address:
  • Phone: 425-977-4620
  • Fax: 425-745-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007149
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: