Provider Demographics
NPI:1235647728
Name:GOODMAN, CAROLYN DAWN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAWN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DAWN
Other - Last Name:TRIVETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 E ROMIE LN STE A
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4031
Mailing Address - Country:US
Mailing Address - Phone:831-755-1701
Mailing Address - Fax:831-755-1702
Practice Address - Street 1:505 E ROMIE LN STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
Practice Address - Country:US
Practice Address - Phone:831-755-1701
Practice Address - Fax:831-755-1702
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95008234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily