Provider Demographics
NPI:1528044575
Name:GOOD, PATRICIA A (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-0109
Mailing Address - Country:US
Mailing Address - Phone:402-887-5440
Mailing Address - Fax:402-887-4564
Practice Address - Street 1:109 W 11TH ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1065
Practice Address - Country:US
Practice Address - Phone:402-887-5440
Practice Address - Fax:402-887-4564
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE110295Medicaid
NES81699Medicare UPIN
NENE110295Medicaid