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General NPI Number Information
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NPI Number | 1366149122
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Entity Type | Individual
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Provider Name | CHENTILE S GOODMAN MSN, CRNP, ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 826 WASHINGTON RD STE 204
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City | WESTMINSTER
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State | MD
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Zip | 21157-5780
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Country | US
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Telephone | 410-525-5144
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Fax | 410-970-4648
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Provider Business Mailing Address
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Address Line | 11332 MARKET ST
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City | FULTON
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State | MD
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Zip | 20759-2645
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Country | US
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Telephone | 619-507-7689
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R215731
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R215731
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R215731
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License Number State | MD
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