Provider Demographics
NPI:1740333905
Name:GOOD, ROY HOWARD (CRNA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:HOWARD
Last Name:GOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 SANDHILL TER NE
Mailing Address - Street 2:
Mailing Address - City:CARLOS
Mailing Address - State:MN
Mailing Address - Zip Code:56319-8168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1771
Practice Address - Country:US
Practice Address - Phone:952-932-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0901484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered