Provider Demographics
NPI:1265865620
Name:GOODRICH, MARION GERTUDE (ARPN)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:GERTUDE
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:140 HIGH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1442
Mailing Address - Country:US
Mailing Address - Phone:866-610-2273
Mailing Address - Fax:413-304-6365
Practice Address - Street 1:140 HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1442
Practice Address - Country:US
Practice Address - Phone:866-610-2273
Practice Address - Fax:413-304-6365
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115090363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology