Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 000041 | SD |
NPI | 1053309740 |
---|---|
Provider Name | Mrs. Sandra Kay Goodman |
First Address | Rapid City, SD 57701-4679 |
Second Address | Rapid City, SD 57701-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 16/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120312 | (05) | MS |
S42128 | (02) | MS |