Provider Demographics
NPI:1073034336
Name:GOODMAN, MORGAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0505
Mailing Address - Country:US
Mailing Address - Phone:1248-249-3571
Mailing Address - Fax:
Practice Address - Street 1:277 ALICE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0505
Practice Address - Country:US
Practice Address - Phone:1248-249-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker