Provider Demographics
NPI:1184143752
Name:GOODMAN, LILLIAN ADELLE (NP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ADELLE
Last Name:GOODMAN
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 1:20375 W 151ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7207
Mailing Address - Country:US
Mailing Address - Phone:913-390-8050
Mailing Address - Fax:913-390-8049
Practice Address - Street 1:20375 W 151ST ST STE 301
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7207
Practice Address - Country:US
Practice Address - Phone:913-390-8050
Practice Address - Fax:913-390-8049
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS85526163WG0000X
KS53-77927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice