Provider Demographics
NPI:1386687523
Name:GOODE, PAULA E (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:E
Last Name:GOODE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:E
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 E RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2344
Mailing Address - Country:US
Mailing Address - Phone:608-373-8000
Mailing Address - Fax:608-373-8006
Practice Address - Street 1:3400 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2344
Practice Address - Country:US
Practice Address - Phone:608-373-8000
Practice Address - Fax:608-373-8006
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI179575-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386687523Medicaid
WI741501891Medicare PIN
WI543400604Medicare PIN