Provider Demographics
NPI:1225747546
Name:GOOD, LAURA ANGLEA (CNM)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANGLEA
Last Name:GOOD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 68TH RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4446
Mailing Address - Country:US
Mailing Address - Phone:781-264-3011
Mailing Address - Fax:
Practice Address - Street 1:522 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3003
Practice Address - Country:US
Practice Address - Phone:718-768-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002189176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife