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General NPI Number Information
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NPI Number | 1215982517
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Entity Type | Individual
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Provider Name | SUZANNE GOODNIGHT
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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 | 10/31/2011
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Provider Practice Location Address
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Address Line | 400 NE MOTHER JOSEPH PL
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City | VANCOUVER
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State | WA
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Zip | 98664-3200
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Country | US
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Telephone | 360-514-2142
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Fax | 360-514-6820
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Provider Business Mailing Address
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Address Line | PO BOX 60000 FILE 74839
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City | SAN FRANCISCO
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State | CA
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Zip | 94160-1600
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Country | US
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Telephone | 360-514-2142
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Fax | 360-514-6820
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA155112
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10004753
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA100004753
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License Number State | WA
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