Provider Demographics
NPI:1063643096
Name:GOODRICH, NANCY A (LPN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-4206
Mailing Address - Country:US
Mailing Address - Phone:845-855-5281
Mailing Address - Fax:
Practice Address - Street 1:51 HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-4206
Practice Address - Country:US
Practice Address - Phone:845-855-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse