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General NPI Number Information
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NPI Number | 1205245610
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Entity Type | Individual
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Provider Name | GLORIA GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 701 E COUNTY LINE RD SUITE 101
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City | GREENWOOD
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State | IN
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Zip | 46143-1072
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Country | US
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Telephone | 317-885-2860
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Fax | 317-885-2335
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Provider Business Mailing Address
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Address Line | 701 E COUNTY LINE RD SUITE 101
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City | GREENWOOD
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State | IN
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Zip | 46143-1072
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Country | US
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Telephone | 317-885-2860
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Fax | 317-885-2335
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | 30004115A
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License Number State | IN
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