Provider Demographics
NPI:1740690783
Name:GOODERMONT, NATALIE RAE (RN, MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:RAE
Last Name:GOODERMONT
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RAE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 N SAN JACINTO ST STE P
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3154
Mailing Address - Country:US
Mailing Address - Phone:951-929-4000
Mailing Address - Fax:951-929-4100
Practice Address - Street 1:540 N SAN JACINTO ST STE P
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-929-4000
Practice Address - Fax:951-929-4100
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily