Provider Demographics
NPI:1568684850
Name:GOODCHILD, HEATHER CHANDA (RN, CNM)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:CHANDA
Last Name:GOODCHILD
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 RED MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8783
Mailing Address - Country:US
Mailing Address - Phone:646-260-5393
Mailing Address - Fax:
Practice Address - Street 1:2855 VALMONT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1309
Practice Address - Country:US
Practice Address - Phone:303-442-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000982367A00000X
CO5806367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30320879Medicaid