Provider Demographics
NPI:1225755630
Name:GOODEN-GOURNEAU, KAREN ALICE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ALICE
Last Name:GOODEN-GOURNEAU
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 1:10364 43RD AVE NE
Mailing Address - Street 2:P.O B.X. 522
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316
Mailing Address - Country:US
Mailing Address - Phone:701-278-5772
Mailing Address - Fax:
Practice Address - Street 1:10364 43RD AVE NE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-5831
Practice Address - Country:US
Practice Address - Phone:701-278-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant