Judy Goodroad Clarke, REGISTERED NURSE
Individual provider Active NPI Registered Nurse · Lakeview, OR
NPI 1265764930 · NPPES record last updated Feb 5, 2010
Key facts
- NPI
- 1265764930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 088003027RN (OR)
- Practice address
- 93893 Leehmann LN
Lakeview, OR 97630-9003 - Phone
- (541) 947-4010
- NPI assigned
- Feb 5, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088003027RN | OR | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 088003027RN | OR | Yes |
Addresses
Primary practice location
93893 Leehmann LN
Lakeview, OR 97630-9003
Mailing address
93893 Leehmann LN
Lakeview, OR 97630-9003
Phone (541) 947-4010
Other providers in Lakeview, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.