Provider Demographics
NPI:1679390009
Name:GOODALL, ANNA TRETHEWEY (RN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:TRETHEWEY
Last Name:GOODALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 DAYLILY LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1575
Mailing Address - Country:US
Mailing Address - Phone:480-406-3302
Mailing Address - Fax:
Practice Address - Street 1:3100 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0962
Practice Address - Country:US
Practice Address - Phone:530-342-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95323000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse