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General NPI Number Information
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NPI Number | 1184679300
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Entity Type | Individual
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Provider Name | CHRISTINE ANNE GOOLD FNP/PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 5144 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-263-8955
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Fax | 707-263-8340
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Provider Business Mailing Address
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Address Line | 2137 PRATO ST
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City | BRENTWOOD
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State | CA
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Zip | 94513-7119
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Country | US
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Telephone | 925-522-1093
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 17490
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 17490
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License Number State | CA
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