Healthcare Provider Details

I. General information

NPI: 1194397760
Provider Name (Legal Business Name): NICOLE MARIE GOODMAN DNP, APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N GATEWAY DR
APPLETON WI
54913-7863
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-380-4999
  • Fax: 920-380-4961
Mailing address:
  • Phone: 920-380-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11064-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: