Provider Demographics
NPI:1326017773
Name:GOODMAN, CARRIE BETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W262S3172 VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-6320
Mailing Address - Country:US
Mailing Address - Phone:262-547-9119
Mailing Address - Fax:
Practice Address - Street 1:2352 N 70TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1320
Practice Address - Country:US
Practice Address - Phone:414-257-3163
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse