Provider Demographics
NPI:1194874016
Name:GOODIEL, ELIZABETH SHELLY (CRNFA,MSN,CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHELLY
Last Name:GOODIEL
Suffix:
Gender:F
Credentials:CRNFA,MSN,CNM
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Mailing Address - Street 1:2028 OPITZ BLVD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3306
Mailing Address - Country:US
Mailing Address - Phone:703-690-2295
Mailing Address - Fax:703-690-6445
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-1500
Practice Address - Fax:703-860-1549
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001074325163W00000X, 367A00000X
VA0024074325363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology