1376552422

Everything you always wanted to know about GOODWATER ELLEN NP but were afraid to ask.

GOODWATER ELLEN NP

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Provider Last Name Provider First Name Provider Credential
GOODWATER ELLEN NP
Gender:
Female
Enumeration date:
2006-08-07
Last update date:
2015-06-03
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
02508276 Medicaid none NY

Taxonomies

Taxonomy State License Number Primary?
367500000X Nurse Anesthetist, Certified Registered NY F331906

Phone Numbers

Type Number
Practice Location Address Fax Number 3153634651
Mailing Address Fax Number 3153632821
Mailing Address Telephone Number 3153632123
Practice Location Address Telephone Number 3153632123

Addresses

Type Address City State Postal Country
Mailing Address PO BOX 2005 SUITE 2 EAST SYRACUSE NY 13057 NY
Practice Location Address 357 GENESEE ST ONEIDA NY 13421 NY

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