Provider Demographics
NPI:1568594497
Name:GOOD, BETH ANN (DNP, APRN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GOOD
Suffix:
Gender:F
Credentials:DNP, APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1602
Mailing Address - Country:US
Mailing Address - Phone:320-496-4663
Mailing Address - Fax:320-679-1239
Practice Address - Street 1:145 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008
Practice Address - Country:US
Practice Address - Phone:320-496-4663
Practice Address - Fax:320-679-1239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR113496-2364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP49448OtherHEALTHPARTNERS
MN376M5GOOtherBLUECROSS BLUE SHIELD
MN704823800Medicaid
MNB19561046969OtherPREFERREDONE
MN62-55214OtherMEDICA UBH
MN890000297Medicare ID - Type Unspecified