Provider Demographics
NPI:1609854512
Name:GOODMAN, WILLIAM LEE (RN, MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEE
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:RN, MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 AVENIDA SEVILLA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6206
Mailing Address - Country:US
Mailing Address - Phone:760-305-7958
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:BOX 555191
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-1395
Practice Address - Fax:760-725-1101
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily