Provider Demographics
NPI:1275411159
Name:GOODHUE, KEAGAN
Entity type:Individual
Prefix:
First Name:KEAGAN
Middle Name:
Last Name:GOODHUE
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 1:5925 KING RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756-9066
Mailing Address - Country:US
Mailing Address - Phone:425-301-8468
Mailing Address - Fax:
Practice Address - Street 1:5925 KING RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756-9066
Practice Address - Country:US
Practice Address - Phone:425-301-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula