Provider Demographics
NPI:1902801665
Name:GOODDING ROBINSON, ROSEMARY L (CNM)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:L
Last Name:GOODDING ROBINSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:L
Other - Last Name:GOODDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:865 LINCOLN RD
Practice Address - Street 2:STE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4159
Practice Address - Country:US
Practice Address - Phone:563-355-1000
Practice Address - Fax:563-344-2975
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB054445367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01693OtherWELLMARK PROVIDER NUMBER
IA01693OtherWELLMARK PROVIDER NUMBER