Provider Demographics
NPI:1659189066
Name:GOODNO, NICOLE LYNN (FUNCTIONAL NUTRITION)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:GOODNO
Suffix:
Gender:F
Credentials:FUNCTIONAL NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W188S7710 OAK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8267
Mailing Address - Country:US
Mailing Address - Phone:414-315-4595
Mailing Address - Fax:
Practice Address - Street 1:W188S7710 OAK GROVE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8267
Practice Address - Country:US
Practice Address - Phone:414-315-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach