Provider Demographics
NPI:1427495167
Name:GOODENOW, TODD NICHOLAS HAMILTON (APRN)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:NICHOLAS HAMILTON
Last Name:GOODENOW
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 KINGSFORD DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6162
Mailing Address - Country:US
Mailing Address - Phone:305-890-7273
Mailing Address - Fax:
Practice Address - Street 1:12 S 8TH ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3020
Practice Address - Country:US
Practice Address - Phone:509-454-4143
Practice Address - Fax:509-454-4115
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9293640163W00000X, 363LA2200X
FLAPRN9293640363L00000X
CA95002588363LG0600X
WAAP61337929363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health