Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101040368 | VA |
N | 207RI0011X | Interventional Cardiology | 0101040368 | VA |
NPI | 1013007657 |
---|---|
Provider Name | Dr. Evelyne Goudreau |
First Address | Richmond, VA 23291-1745 |
Second Address | Richmond, VA 23298-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6030343 | (05) | VA |
D81983 | (02) |