Jacqueline Venora Goodgame, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703103750 Issued in MI

Practice address

4000 Town Ctr
Southfield, MI 48075

Phone

(248) 386-0300

NPI assigned

Jul 6, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Laurels of Carson City, LLC

  • Skilled Nursing Facility
  • Carson City, MI
  • NPI 1417171844
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1073009627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 TOWN CTR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 TOWN CTR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-386-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODGAME",
        "first_name": "JACQUELINE",
        "middle_name": "VENORA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-06",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703103750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Good Faith Manor LLC
• Good Health and Aging Well on Purpose Counseling and Coaching Center P
• Ella Good
• Sandra Ann Goodall, LLP
• Robert Lawrence Goode, DDS
• Gary R Goodman, MD
• Madison Leigh Goodman, PA-C
• Peter M Goodman, M.D.
• Robert Goodman, DMD
• Theresa Goodrich

• Licensed Practical Nurse in Southfield, MI
• Providers in Southfield, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.