Provider Demographics
NPI:1326642075
Name:BIGELOW, ANNETTE GOODMAN (RN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:GOODMAN
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34556 N APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4431
Mailing Address - Country:US
Mailing Address - Phone:480-689-1037
Mailing Address - Fax:
Practice Address - Street 1:34556 N APPALOOSA WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85142-4431
Practice Address - Country:US
Practice Address - Phone:480-689-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238220163W00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No163W00000XNursing Service ProvidersRegistered Nurse