Provider Demographics
NPI:1568231447
Name:GOODBAND, TUESDAY REVE'
Entity Type:Individual
Prefix:
First Name:TUESDAY
Middle Name:REVE'
Last Name:GOODBAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TUESDAY
Other - Middle Name:REVE'
Other - Last Name:GOODBAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:68 GANSON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7213
Mailing Address - Country:US
Mailing Address - Phone:716-438-6571
Mailing Address - Fax:
Practice Address - Street 1:68 GANSON ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7213
Practice Address - Country:US
Practice Address - Phone:716-438-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348967164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse