Provider Demographics
NPI:1790966117
Name:GOODYEAR, ELIZABETH KAY (RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:GOODYEAR
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 CENTER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4640
Mailing Address - Country:US
Mailing Address - Phone:925-313-8986
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4640
Practice Address - Country:US
Practice Address - Phone:925-313-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433005163WC0400X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant