Provider Demographics
NPI:1801409396
Name:GOODMAN, ANTOINETTE M
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 FREEWAY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1751
Mailing Address - Country:US
Mailing Address - Phone:612-430-9298
Mailing Address - Fax:833-736-7476
Practice Address - Street 1:2800 FREEWAY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-1751
Practice Address - Country:US
Practice Address - Phone:612-430-9298
Practice Address - Fax:833-736-7476
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program