Provider Demographics
NPI:1992364939
Name:GOODLIN, GRANT DAVID (FNP)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:DAVID
Last Name:GOODLIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5501
Mailing Address - Country:US
Mailing Address - Phone:530-713-1577
Mailing Address - Fax:
Practice Address - Street 1:900 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5832
Practice Address - Country:US
Practice Address - Phone:530-534-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily