Basic Information
| Provider Information | |||||||||
| NPI: | 1528044575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 109 | ||||||||
| Address2: | |||||||||
| City: | NELIGH | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687560109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028875440 | ||||||||
| FaxNumber: | 4028874564 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | NELIGH | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687561065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028875440 | ||||||||
| FaxNumber: | 4028874564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 110295 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NE110295 | 05 | NE | MEDICAID |