Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 19109.0857 | WY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19109.0857 | WY |
NPI | 1023099637 |
---|---|
Provider Name | Julian Good |
First Address | Cheyenne, WY 82001-2760 |
Second Address | Cheyenne, WY 82001-2760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123919800 | (05) | WY |
P78877 | (02) | WY |