Basic Information
| Provider Information | |||||||||
| NPI: | 1043263486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RN, APN,C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 156 OAKWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOGOTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076031722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019965437 | ||||||||
| FaxNumber: | 2014571885 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019965437 | ||||||||
| FaxNumber: | 2014571885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NO07828400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.