Provider Demographics
NPI:1487760369
Name:GOODMAN, PETRA (NP)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:GOODMAN
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:USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 446, UNIT 26610
Mailing Address - City:WUERZBURG
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:APO AE 09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG, ATTN: PRIMARY CARE CLINIC
Practice Address - Street 2:CMR 446, UNIT 26610
Practice Address - City:WUERZBURG
Practice Address - State:BAVARIA
Practice Address - Zip Code:APO AE 09244
Practice Address - Country:DE
Practice Address - Phone:01149931-804-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCWH 1574363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health