Provider Demographics
NPI:1437138302
Name:GOODALL, MICHAEL C (RNFA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:GOODALL
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1645
Mailing Address - Country:US
Mailing Address - Phone:563-344-0786
Mailing Address - Fax:563-344-7536
Practice Address - Street 1:1414 W LOMBARD STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2148
Practice Address - Country:US
Practice Address - Phone:563-322-0971
Practice Address - Fax:563-322-1780
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA049407163WM0705X
IL041322709163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical