Provider Demographics
NPI:1477681575
Name:GOODE, MARY ALICE (MSN, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:GOODE
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:G
Other - Last Name:SATTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNA
Mailing Address - Street 1:7348 PRINCESS ANNE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1338
Mailing Address - Country:US
Mailing Address - Phone:919-604-3971
Mailing Address - Fax:
Practice Address - Street 1:7348 PRINCESS ANNE DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1338
Practice Address - Country:US
Practice Address - Phone:919-604-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120351367500000X
VA0001180074163W00000X
MERNA183048367500000X
VA0024165253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse