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General NPI Number Information
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NPI Number | 1811792732
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Entity Type | Individual
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Provider Name | AMANDA GOODBEAR LPN
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Gender | Female
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 5586 CHRISTOPHER DR
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3830
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Country | US
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Telephone | 715-896-7877
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Fax |
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Provider Business Mailing Address
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Address Line | W8838 THUNDERCLOUD RD
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-6421
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Country | US
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Telephone | 715-896-7877
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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 | 321718-31
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License Number State | WI
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