Provider Demographics
NPI:1043676166
Name:GOODRICH, AMBER LOIS (CNM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOIS
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:EVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-8218
Mailing Address - Fax:319-384-8620
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-8218
Practice Address - Fax:319-384-8620
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB127930367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife