Provider Demographics
NPI:1003015413
Name:GOODFRIEND-REANO, EVA L (CNM)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:L
Last Name:GOODFRIEND-REANO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 MCGEE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1632
Mailing Address - Country:US
Mailing Address - Phone:510-848-1352
Mailing Address - Fax:510-323-2361
Practice Address - Street 1:2216 MCGEE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1632
Practice Address - Country:US
Practice Address - Phone:510-848-1352
Practice Address - Fax:510-323-2361
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1778367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife