Provider Demographics
NPI:1528084308
Name:GOODMAN, REBECCA (RNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE PO BOX 684 SIERRA BOSDYK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-784-9503
Mailing Address - Fax:585-784-8207
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-1122
Practice Address - Country:US
Practice Address - Phone:585-275-2662
Practice Address - Fax:585-461-9636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P019330760OtherBLUE CHOICE
175009BSOtherPREFERRED CARE
175009BSOtherPREFERRED CARE