Provider Demographics
NPI:1518308253
Name:GOUDEAU, MAURICE DAVID (RN)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:DAVID
Last Name:GOUDEAU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 NE 37TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4906
Mailing Address - Country:US
Mailing Address - Phone:360-600-1204
Mailing Address - Fax:360-573-3829
Practice Address - Street 1:12902 NE 37TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-4906
Practice Address - Country:US
Practice Address - Phone:360-600-1204
Practice Address - Fax:360-573-3829
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60721245163W00000X
OR098007012RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse