Provider Demographics
NPI:1316248628
Name:GOODEN-SPEARMAN, CAROLYN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:GOODEN-SPEARMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4502 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1817
Mailing Address - Country:US
Mailing Address - Phone:602-764-1007
Mailing Address - Fax:
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP036775164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse