Provider Demographics
NPI:1174281901
Name:GOODBAN, NANCY JAYNE
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JAYNE
Last Name:GOODBAN
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 1:5610 N AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8545
Mailing Address - Country:US
Mailing Address - Phone:308-233-2558
Mailing Address - Fax:
Practice Address - Street 1:5610 N AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8545
Practice Address - Country:US
Practice Address - Phone:308-233-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14571347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker