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General NPI Number Information
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NPI Number | 1831492610
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Entity Type | Individual
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Provider Name | BECKY GOODSON
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Gender | Female
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 1111 S STAPLEY DR STE 111
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City | MESA
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State | AZ
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Zip | 85204-5060
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Country | US
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Telephone | 480-398-1220
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Fax | 480-398-1230
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Provider Business Mailing Address
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Address Line | 2531 S GILBERT RD STE 111
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City | GILBERT
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State | AZ
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Zip | 85295-5892
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Country | US
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Telephone | 480-398-1220
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Fax | 480-983-4317
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN137766
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP3868
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License Number State | AZ
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