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General NPI Number Information
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NPI Number | 1063634475
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Entity Type | Individual
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Provider Name | CARRIE CHRISTINA GOODRUM FNP
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1520 S. DOBSON RD. SUITE 203
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City | MESA
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State | AZ
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Zip | 85202
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Country | US
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Telephone | 480-461-8400
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Fax | 480-461-8408
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Provider Business Mailing Address
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Address Line | 4511 E. BRIARWOOD TERRACE
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-272-7816
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Fax | 480-461-8408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP2157
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License Number State | AZ
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