Provider Demographics
NPI:1972844157
Name:GOODGE, ANNA LEAH (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEAH
Last Name:GOODGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S STRATFORD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5901
Mailing Address - Country:US
Mailing Address - Phone:805-928-5767
Mailing Address - Fax:805-349-0222
Practice Address - Street 1:206 S STRATFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5901
Practice Address - Country:US
Practice Address - Phone:805-928-5767
Practice Address - Fax:805-349-0222
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily