Provider Demographics
NPI:1629873047
Name:GOODMAN, KAREN LESLIE (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LESLIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LESLIE
Other - Last Name:DITTMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3403 N 187TH PLZ APT 703
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4306
Mailing Address - Country:US
Mailing Address - Phone:402-992-3384
Mailing Address - Fax:
Practice Address - Street 1:20005 FARNAM ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4859
Practice Address - Country:US
Practice Address - Phone:402-992-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15283164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse