Provider Demographics
NPI:1285214890
Name:GOODMANSON, JEANETTE MARIE
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:GOODMANSON
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 1:141 E WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6007
Mailing Address - Country:US
Mailing Address - Phone:561-736-1010
Mailing Address - Fax:561-736-1272
Practice Address - Street 1:141 E WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6007
Practice Address - Country:US
Practice Address - Phone:561-736-1010
Practice Address - Fax:561-736-1272
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1012192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse