Provider Demographics
NPI:1104181320
Name:GOODLY, MARSHA L
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:L
Last Name:GOODLY
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 1:4135 LAREDO CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-0954
Mailing Address - Country:US
Mailing Address - Phone:337-564-5672
Mailing Address - Fax:337-475-4820
Practice Address - Street 1:3236 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8640
Practice Address - Country:US
Practice Address - Phone:337-480-2614
Practice Address - Fax:337-475-4820
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN085620163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health