Provider Demographics
NPI:1689064644
Name:GOODMAN, ERIC (RN, CWOCN, CFCN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:RN, CWOCN, CFCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3051
Mailing Address - Country:US
Mailing Address - Phone:630-235-1108
Mailing Address - Fax:
Practice Address - Street 1:418 OTIS AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3051
Practice Address - Country:US
Practice Address - Phone:630-235-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041332410163W00000X, 163WC2100X, 163WE0900X, 163WH0200X, 163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care