Provider Demographics
NPI:1497353882
Name:GOODE, BREANNA JANE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:JANE
Last Name:GOODE
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 1:66 CLEARBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BUD
Mailing Address - State:WV
Mailing Address - Zip Code:24716
Mailing Address - Country:US
Mailing Address - Phone:304-320-3838
Mailing Address - Fax:
Practice Address - Street 1:66 CLEARBROOK AVE
Practice Address - Street 2:
Practice Address - City:BUD
Practice Address - State:WV
Practice Address - Zip Code:24716
Practice Address - Country:US
Practice Address - Phone:304-320-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant