Provider Demographics
NPI:1043349830
Name:GOODMAN, STEFFIE S (PHD, CNM)
Entity Type:Individual
Prefix:
First Name:STEFFIE
Middle Name:S
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF COLORADO BOULDER
Mailing Address - Street 2:119 UCB, 1900 WARDENBURG DRIVE
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-5101
Mailing Address - Country:US
Mailing Address - Phone:303-492-2030
Mailing Address - Fax:303-735-3544
Practice Address - Street 1:UNIVERSITY OF COLORADO BOULDER
Practice Address - Street 2:119 UCB, 1900 WARDENBURG DRIVE
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-5101
Practice Address - Country:US
Practice Address - Phone:303-492-2030
Practice Address - Fax:303-735-3544
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96481367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07964810Medicaid
COR78725Medicare UPIN