Provider Demographics
NPI:1902988769
Name:GOODNER, MARY ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:GOODNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 HART LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37247-0802
Mailing Address - Country:US
Mailing Address - Phone:615-650-7037
Mailing Address - Fax:615-262-6139
Practice Address - Street 1:1324 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3784
Practice Address - Country:US
Practice Address - Phone:615-794-1542
Practice Address - Fax:615-790-5967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN118705163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN118705OtherRN LICENSE
TN7751OtherAPN LICENSE