Provider Demographics
NPI:1629845938
Name:GOODNER, HILARY (CPM, LM)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:GOODNER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29367 E 159TH ST S
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-5587
Mailing Address - Country:US
Mailing Address - Phone:918-693-2186
Mailing Address - Fax:918-800-2280
Practice Address - Street 1:29367 E 159TH ST S
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-5587
Practice Address - Country:US
Practice Address - Phone:918-693-2186
Practice Address - Fax:918-800-2280
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMIDW0045176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife