Active NPI
Shana Goodman, RN
- Registered Nurse
- Manitowoc, WI
National Provider Identifier
1609151182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 179390030
- Practice address
- 1624 Hillcrest Dr
Manitowoc, WI 54220-1825 - Phone
- (920) 905-3568
- NPI assigned
- Oct 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 179390030 | WI | Primary |
Addresses
Primary practice location
1624 Hillcrest Dr
Manitowoc, WI 54220-1825
Mailing address
1624 Hillcrest Dr
Manitowoc, WI 54220-1825
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 179390030 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1609151182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 HILLCREST DR",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542201825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1624 HILLCREST DR",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542201825",
"telephone_number": "920-905-3568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "SHANA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-17",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "179390030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.