Provider Demographics
NPI:1942938972
Name:GOODSPEED, AMANDA MERCEDES (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MERCEDES
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BROADVIEW TER
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-1101
Mailing Address - Country:US
Mailing Address - Phone:518-742-9148
Mailing Address - Fax:
Practice Address - Street 1:10 LA CROSS ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1415
Practice Address - Country:US
Practice Address - Phone:518-746-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797024163WS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse