Basic Information
| Provider Information | |||||||||
| NPI: | 1124158068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 410 | ||||||||
| Address2: | |||||||||
| City: | NEAH BAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983570410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606452421 | ||||||||
| FaxNumber: | 3606452305 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 FORT STREET | ||||||||
| Address2: | |||||||||
| City: | NEAH BAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606452421 | ||||||||
| FaxNumber: | 3606452305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00162267 | WA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.