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General NPI Number Information
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NPI Number | 1861893414
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Entity Type | Individual
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Provider Name | BENJAMIN ASHBY GOODRUM CNM, FNP
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Gender | Male
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2450 ASHBY AVE
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City | BERKELEY
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State | CA
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Zip | 94705-2067
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Country | US
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Telephone | 510-204-3977
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201406326NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | F002184-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | CNM236316
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License Number State | CA
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