Provider Demographics
NPI:1366149122
Name:GOODMAN, CHENTILE S (MSN, CRNP, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:CHENTILE
Middle Name:S
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSN, CRNP, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11332 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2645
Mailing Address - Country:US
Mailing Address - Phone:619-507-7689
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON RD STE 204
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5780
Practice Address - Country:US
Practice Address - Phone:410-525-5144
Practice Address - Fax:410-970-4648
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215731363L00000X, 363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care