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General NPI Number Information
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NPI Number | 1184030041
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Entity Type | Individual
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Provider Name | JENNIFER GOODALL I LPN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 427 N MAIN ST APT 20
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1040
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Country | US
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Telephone | 585-662-7252
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Fax |
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Provider Business Mailing Address
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Address Line | 427 N MAIN ST APT 20
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1040
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Country | US
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Telephone | 585-662-7252
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 317243
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License Number State | NY
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