Provider Demographics
NPI:1568779809
Name:GOODNO, SHANA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:GOODNO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 31ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6703
Mailing Address - Country:US
Mailing Address - Phone:229-217-0088
Mailing Address - Fax:
Practice Address - Street 1:207 31 ST AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-217-0088
Practice Address - Fax:229-217-0087
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner