Provider Demographics
NPI:1841282753
Name:GOUDY-EGGER, LAYNETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:LAYNETTE
Middle Name:
Last Name:GOUDY-EGGER
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 1:2990 W GRAND BLVD
Mailing Address - Street 2:STE 307
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3081
Mailing Address - Country:US
Mailing Address - Phone:248-423-1550
Mailing Address - Fax:248-423-1552
Practice Address - Street 1:29556 SOUTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2021
Practice Address - Country:US
Practice Address - Phone:248-423-1550
Practice Address - Fax:248-423-1552
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114991363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00218409OtherMEDICARE RAILROAD
MI4654399Medicaid
MI5008604330OtherBCBS
MI0N99340001Medicare PIN
MIP00218409OtherMEDICARE RAILROAD
MI5008604330OtherBCBS
MI4654399Medicaid
MI0N99340Medicare ID - Type Unspecified001