Provider Demographics
NPI:1720046246
Name:GOODE, DIANE SUE (RNC, NNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:SUE
Last Name:GOODE
Suffix:
Gender:F
Credentials:RNC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2133
Mailing Address - Country:US
Mailing Address - Phone:540-366-4185
Mailing Address - Fax:
Practice Address - Street 1:7195 SCARLET OAK DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2133
Practice Address - Country:US
Practice Address - Phone:540-366-4185
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024038393363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal