Healthcare Provider Details

I. General information

NPI: 1427495167
Provider Name (Legal Business Name): TODD NICHOLAS HAMILTON GOODENOW APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S 8TH ST
YAKIMA WA
98901-3020
US

IV. Provider business mailing address

1441 KINGSFORD DR
CARMICHAEL CA
95608-6162
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-4143
  • Fax: 509-454-4115
Mailing address:
  • Phone: 305-890-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9293640
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9293640
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95002588
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61337929
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9293640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: